What is the expected urine output after administration of 60 mg of Lasix (furosemide) intravenously (IV)?

From the Guidelines

After administering 60 mg of Lasix (furosemide) intravenously, a urine output of approximately 2-3 liters over the next 4-6 hours can be expected, although this may vary based on individual patient factors such as kidney function and hydration status 1. This expected diuretic response is guided by the principles outlined in the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure, which recommend monitoring symptoms, urine output, renal function, and electrolytes during the use of intravenous diuretics 1. The mechanism of action of furosemide, inhibiting sodium and chloride reabsorption in the loop of Henle, leads to increased water excretion and thus significant diuresis. Key considerations in managing patients receiving intravenous furosemide include:

• Monitoring fluid balance and electrolyte changes closely, particularly potassium levels
• Ensuring adequate hydration before and during treatment to prevent excessive fluid loss and electrolyte imbalances
• Adjusting the dose and duration of diuretic therapy according to the patient's symptoms and clinical status, as recommended by the guidelines 1. It is crucial to tailor the management approach to the individual patient's needs, taking into account factors such as underlying medical conditions, kidney function, and the presence of any symptoms or signs of heart failure, to optimize outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

The onset of diuresis following intravenous administration is within 5 minutes and somewhat later after intramuscular administration. The peak effect occurs within the first half hour. The duration of diuretic effect is approximately 2 hours Furosemide is predominantly excreted unchanged in the urine

The expected urine output after administration of 60 mg of Lasix (furosemide) intravenously (IV) is not explicitly stated in the drug label. However, it can be inferred that there will be an increase in urine output due to the diuretic effect of furosemide, with the peak effect occurring within the first half hour and the duration of diuretic effect lasting approximately 2 hours 2.

From the Research

Expected Urine Output after Administration of 60 mg of Lasix (Furosemide) IV

• The expected urine output after administration of 60 mg of Lasix (furosemide) intravenously (IV) can be estimated based on the available studies.
• A study published in 2016 3 analyzed 60 consecutive patients with chronic heart failure and clinical evidence of worsening congestion who received a bolus and 3-h IV infusion of furosemide at an outpatient HF clinic. The median urine output for the entire cohort was 1.1 l (IQR: 0.6 to 1.4 l).
• Another study published in 2012 4 investigated the effect of furosemide-forced diuresis and intravenous saline infusion matched with urine output. The study found that furosemide-induced high urine output with matched hydration significantly reduces the risk of contrast-induced nephropathy.
• A study published in 2015 5 found that hypertonic saline solution added to furosemide increased total urine output, sodium excretion, urinary osmolality, and furosemide urine delivery in all patients and at all time points.
• A study published in 2018 6 analyzed patient data from the National Heart, Lung, and Blood Institute Heart Failure Network clinical trials and found that diuretic efficiency was defined as total 72-hour fluid output per total equivalent loop diuretic dose. The high-DE group had a median fluid output of 9071 ml (interquartile range: 7240-11775) with a median furosemide dose of 320 mg.
• A study published in 2002 7 found that prophylactic continuous infusion of furosemide after the maze procedure for atrial fibrillation resulted in a higher mean postoperative urinary output and fewer pulmonary complications compared to bolus doses.

Urine Output Estimates

• Based on the available studies, the expected urine output after administration of 60 mg of Lasix (furosemide) IV can be estimated to be around 1-2 liters over a period of 2-4 hours 3, 4, 5.
• However, it's essential to note that individual responses to furosemide may vary, and urine output can be influenced by factors such as renal function, hydration status, and underlying medical conditions 6, 7.