What are the treatment options for organ failure symptoms?

From the Guidelines

Treatment for organ failure symptoms should prioritize immediate medical intervention, including hospitalization and supportive measures, along with medications such as diuretics, vasopressors, and specific organ-targeted treatments to improve symptoms, prevent worsening, and increase survival. The choice of treatment depends on the specific organ affected and the severity of failure. For acute heart failure, guidelines recommend the use of diuretics, such as furosemide, to reduce fluid overload, with an initial dose of 20-40 mg i.v. for patients not on chronic diuretic therapy 1. Vasodilators may also be considered for symptomatic relief in patients with systolic blood pressure >90 mmHg 1.

Key considerations in managing organ failure include:

• Identifying the underlying cause of organ failure to prevent further deterioration and potentially allow for organ recovery
• Providing nutritional support, pain management, and infection prevention as crucial components of treatment
• Considering transplantation as a definitive treatment for end-stage organ failure, depending on organ availability and patient eligibility
• Focusing on palliative care when curative options are limited, emphasizing symptom management and quality of life

In the context of heart failure, specific treatments may include:

• Beta-blockers, such as carvedilol, to reduce the risk of heart failure hospitalization and death, with careful consideration of potential side effects like dizziness or symptomatic hypotension 1
• ACE inhibitors, which are recommended in addition to beta-blockers for symptomatic patients with heart failure with reduced ejection fraction to reduce the risk of hospitalization and death 1
• Monitoring for worsening symptoms or signs, such as increasing dyspnea, fatigue, or edema, and adjusting treatment accordingly, which may include increasing the dose of diuretics or adjusting beta-blocker doses 1

Given the complexity and variability of organ failure, a comprehensive approach that addresses the specific needs of the patient, including the severity of symptoms, the underlying cause of organ failure, and the presence of concomitant diseases, is essential. This approach should be guided by the most recent and highest-quality evidence available, such as the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1, to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

5.3 Impaired Renal Function Monitor renal function periodically in patients treated with lisinopril. Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system.

The treatment options for organ failure symptoms are not directly addressed in the provided drug labels. However, lisinopril and spironolactone can cause or worsen certain conditions that may lead to organ failure, such as:

• Acute renal failure due to decreased renal function
• Hyperkalemia which can be life-threatening
• Hypotension which can lead to decreased organ perfusion

It is essential to monitor renal function and serum potassium levels regularly in patients taking these medications, especially those with pre-existing renal impairment or other risk factors. If organ failure symptoms occur, the treatment approach should be individualized and may involve:

• Discontinuing or adjusting the medication
• Providing supportive care to manage symptoms and prevent further complications
• Consulting with a specialist or a healthcare professional for guidance on managing the condition 2 3.

From the Research

Treatment Options for Organ Failure Symptoms

The treatment options for organ failure symptoms, particularly in the context of heart failure, involve a combination of pharmacologic therapies aimed at managing symptoms, improving survival, and reducing hospitalizations.

• Mainstay Therapies:
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Beta-blockers (such as bisoprolol, carvedilol, and metoprolol XL/CR)
  • Diuretics to control fluid balance 4
• Alternative and Additional Therapies:
  • Valsartan can be substituted in patients who cannot tolerate ACE inhibitors due to angioedema or severe cough 4
  • Spironolactone is recommended for patients with New York Heart Association (NYHA) class III to IV symptoms despite maximal therapies with ACE inhibitors, beta-blockers, diuretics, and digoxin 4, 5
  • Low-dose digoxin can be added to improve symptoms and possibly mortality 4
  • The combination of hydralazine and isosorbide dinitrate might be useful in patients who cannot tolerate ACE inhibitors or valsartan due to hypotension or renal dysfunction 4
• Role of Beta-Blockers:
  • Beta-blockers are highly effective for patients with all grades of heart failure secondary to left ventricular systolic dysfunction 6, 7
  • They should be initiated early in the course of the disease and started in low doses with slow titration over weeks or months before reaching maintenance doses 6, 7
• Other Considerations:
  • Anticoagulation is recommended only in patients with concomitant atrial fibrillation or a previous history of cerebral or systemic emboli 4
  • Amiodarone should be used only in patients with a history of sudden death, ventricular fibrillation, or sustained ventricular tachycardia, and in conjunction with an implantable defibrillator 4