How do I chart a furosemide (frusemide) infusion?

Charting a Furosemide Infusion

For a furosemide (frusemide) infusion, administer a 40-mg IV loading dose followed by a continuous infusion of 10-40 mg per hour, with regular monitoring of urine output, renal function, and electrolytes. 1

Preparation and Administration Protocol

Initial Setup:

• Document baseline vital signs, weight, and fluid status
• Ensure IV access is patent and appropriate for medication administration
• Place urinary catheter to accurately monitor output

Dosing Protocol:

1. Loading dose: 40 mg IV bolus 1
2. Continuous infusion: Start at 10 mg/hour and titrate as needed up to 40 mg/hour 1
3. Maximum daily dose: Generally not to exceed 240 mg in the first 24 hours 1

Monitoring Requirements (document at regular intervals):

• Urine output (hourly)
• Fluid balance (intake/output)
• Blood pressure (every 15-30 minutes initially, then hourly when stable)
• Heart rate
• Serum electrolytes (particularly potassium, sodium)
• Renal function (creatinine, BUN)
• Daily weight

Charting Elements

Documentation in Medical Record:

• Date and time of infusion initiation
• Loading dose administered
• Initial infusion rate
• Titration changes (time and new rate)
• Total daily dose
• Urine output response
• Electrolyte replacement (if needed)
• Clinical response (improvement in edema, respiratory status, etc.)
• Adverse effects (if any)

Infusion Rate Adjustments:

• Document any rate changes with clinical rationale
• Record time of each adjustment
• Note urine output response to rate changes

Clinical Decision Points

When to Increase Rate:

• Inadequate urine output (< 100 mL/hour over 1-2 hours) 1
• Persistent signs of fluid overload
• Document clinical assessment supporting rate increase

When to Decrease Rate:

• Excessive diuresis (risk of volume depletion)
• Hypotension (SBP < 90 mmHg)
• Electrolyte abnormalities (hypokalemia, hyponatremia)
• Worsening renal function

Important Considerations and Pitfalls

Potential Complications to Monitor and Document:

• Electrolyte disturbances (especially hypokalemia and hyponatremia)
• Hypotension
• Dehydration
• Ototoxicity (with high doses or rapid administration)
• Acute kidney injury

Efficacy Assessment:

• Continuous infusion has been shown to be more efficient than intermittent boluses, requiring significantly less total furosemide dose to achieve the same diuretic effect 2
• Document the relationship between dose administered and urine output (mL/mg) to assess efficiency

Discontinuation:

• Document plan for transition to oral diuretics when appropriate
• Record total duration of infusion therapy
• Note clinical status at time of discontinuation

Remember that continuous infusion provides more consistent diuresis with potentially fewer side effects compared to bolus dosing, but requires careful monitoring and documentation of response and complications 2.