From the Guidelines
The maximum dose of Bumex (bumetanide) drip in a critical care setting should not exceed 2 mg per hour infusion, as recommended in the most recent guidelines 1. When administering bumetanide as a continuous infusion, it is typically started at 0.5-1 mg/hour after an initial bolus dose. The medication should be diluted in compatible solutions such as normal saline or D5W. Key considerations for bumetanide administration include:
- Close monitoring of electrolytes, especially potassium, sodium, and magnesium, during administration
- Monitoring of fluid status, blood pressure, and renal function
- Dose adjustments may be necessary for patients with renal impairment
- The infusion rate should be titrated based on urine output and clinical response Bumetanide is a potent loop diuretic that works by inhibiting sodium and chloride reabsorption in the ascending loop of Henle, resulting in increased excretion of water, sodium, chloride, and potassium. It is approximately 40 times more potent than furosemide on a milligram basis, as noted in guidelines 1. Higher doses may occasionally be used with close monitoring, but the maximum single dose should not exceed 4 to 8 mg, as indicated in the guidelines 1.
From the Research
Maximum Dose of Bumex Drip
The maximum dose of Bumex (bumetanide) drip in a critical care setting is not strictly defined, but several studies provide guidance on dosing practices.
- The dose of bumetanide can range from 0.5 to 2 mg/day for patients with oedema due to congestive heart failure, pulmonary oedema, or hepatic disease 2.
- Higher doses of bumetanide, up to 15 mg/day, may be required in patients with chronic renal failure or nephrotic syndrome 2.
- In critically ill pediatric patients, a mean dose of 5.7 μg/kg/hr (1-10 μg/kg/hr) was effective in achieving negative fluid balance 3.
- In adults, a mean dose of 1.08 ± 0.43 mg/hour was used in a systematic review and meta-analysis of continuous bumetanide infusion for heart failure, acute kidney injury, or volume overload 4.
- Increasing doses of bumetanide were correlated with increased urine output and increased incidence of acute kidney injury (AKI) 4.
- In critically ill infants, maximal diuretic responses occurred at a bumetanide excretion rate of about 7 micrograms/kg/hr, corresponding to doses of 0.035 to 0.040 mg/kg 5.
Considerations for Dosing
- The dose of bumetanide should be individualized based on the patient's response and clinical status.
- Close monitoring for adverse effects, such as hypokalemia and AKI, is necessary when using bumetanide, especially at higher doses 2, 4.
- Combination with other diuretics, such as thiazide diuretics, may enhance the clinical response to bumetanide 2, 6.