Management of Lasix Infusion During Cytosorb Therapy
Furosemide (Lasix) infusion should be continued with caution during Cytosorb therapy, but only in patients with evidence of intravascular fluid overload and not in those with hypovolemia.
Assessment of Volume Status
When deciding whether to continue Lasix infusion during Cytosorb therapy, careful assessment of volume status is critical:
Signs of intravascular fluid overload (continue Lasix):
- Good peripheral perfusion
- Normal or elevated blood pressure
- Pulmonary congestion
- Peripheral edema
Signs of hypovolemia (discontinue Lasix):
- Prolonged capillary refill time
- Tachycardia
- Hypotension
- Oliguria or acute kidney injury
- Abdominal discomfort
Recommendations for Lasix Management During Cytosorb
When to continue Lasix:
- In patients with confirmed intravascular fluid overload 1
- When there is evidence of pulmonary edema or peripheral edema
- When blood pressure is maintained (>90 mmHg) 2
When to discontinue Lasix:
- In patients with hypovolemia or signs of poor perfusion 1
- In the presence of marked hyponatremia 1
- In case of anuria 1
- When there is risk of thrombosis due to hypovolemia 1
Monitoring During Combined Therapy
Patients receiving both Cytosorb and Lasix require close monitoring of:
- Fluid status (daily weight, intake/output)
- Electrolytes (especially potassium and sodium)
- Renal function (creatinine, BUN)
- Blood pressure and heart rate
- Urine output
Dosing Considerations
When continuing Lasix during Cytosorb therapy:
- Consider lower doses initially (0.5-2 mg/kg per dose) 1
- Maximum dose should not exceed 10 mg/kg per day 1
- High doses (>6 mg/kg/day) should not be given for periods longer than 1 week 1
- Infusions should be administered over 5-30 minutes to avoid hearing loss 1
Important Considerations
- Cytosorb can potentially remove medications including some antibiotics, antiarrhythmics, and possibly diuretics, though specific data on furosemide removal is limited 3
- Furosemide can transiently increase pulmonary capillary wedge pressure and decrease cardiac output in heart failure patients 1
- In patients with septic shock receiving Cytosorb, careful attention to hemodynamics is essential as these patients may be particularly vulnerable to the effects of diuretics 4
Clinical Pitfalls to Avoid
- Continuing Lasix in hypovolemic patients can worsen perfusion and increase risk of thrombosis 1
- Discontinuing Lasix in patients with true volume overload may worsen pulmonary edema
- Failing to monitor electrolytes can lead to dangerous imbalances, especially hypokalemia
- Not recognizing that Cytosorb may affect the pharmacokinetics of concurrently administered medications 3
By carefully assessing volume status and following these guidelines, the decision to continue or discontinue Lasix infusion during Cytosorb therapy can be made to optimize patient outcomes and minimize complications.