Can Lasix (furosemide) be given to a patient with impaired renal function (creatinine level of 1.42)?

Administration of Furosemide with Creatinine of 1.42

Yes, furosemide can be administered to a patient with a creatinine level of 1.42, but dose adjustment and careful monitoring are required. 1

Renal Function Considerations

Furosemide can be used in patients with impaired renal function, but several important factors must be considered:

• A creatinine level of 1.42 mg/dL indicates moderate renal impairment but does not contraindicate furosemide use
• Unlike metformin, which should not be given to men with creatinine ≥1.5 mg/dL and women with creatinine ≥1.4 mg/dL, furosemide can still be administered 1
• The FDA label for furosemide recommends more frequent monitoring of renal function in patients with renal insufficiency 2

Dosing Recommendations

When administering furosemide to patients with impaired renal function:

• Start with a standard dose (typically 40 mg) and assess response
• Monitor the patient's response closely, as the diuretic effect may be reduced due to decreased renal clearance
• Consider extending the dosing interval rather than reducing the dose to maintain efficacy 1
• For patients with severe renal impairment (creatinine clearance <30 mL/min), more careful monitoring is required, but furosemide can still be effective 1

Monitoring Requirements

Close monitoring is essential when administering furosemide to patients with elevated creatinine:

• Check serum electrolytes (particularly potassium), CO2, creatinine, and BUN frequently during the first few months of therapy 2
• Monitor more frequently when the patient is vomiting or receiving parenteral fluids 2
• Assess for signs of fluid or electrolyte imbalance: dry mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle cramps, hypotension, oliguria, tachycardia, or arrhythmia 2
• Consider checking serum calcium and magnesium periodically 2

Potential Risks and Precautions

Several risks should be considered when using furosemide in patients with elevated creatinine:

• Furosemide may cause transient worsening of renal function, with mean creatinine increases of approximately 0.2 mg/dL during therapy 3
• Combined use with ACE inhibitors or ARBs increases the risk of acute kidney injury, especially in volume-depleted states 4, 2
• High-dose furosemide (>80 mg/day) requires even more careful monitoring 1
• Elderly patients and those with frailty are at higher risk of adverse effects 4

When to Adjust or Discontinue Therapy

Furosemide should be adjusted or discontinued in the following situations:

• If there is severe hyponatremia (serum sodium <120 mmol/L) 1
• If there is progressive renal failure 1
• If there is worsening hepatic encephalopathy 1
• If the patient develops incapacitating muscle cramps 1
• If severe hypokalemia (<3 mmol/L) occurs 1

Clinical Evidence

Despite concerns about renal function, evidence supports the use of furosemide in patients with impaired renal function:

• A study of patients with severe chronic heart failure and reduced renal function (mean creatinine clearance 32 mL/min) showed that high-dose furosemide was effective in achieving natriuresis and symptom relief 5
• Even in patients with moderate renal impairment, furosemide can produce adequate diuresis during the first 4 hours following administration 6

In conclusion, furosemide can be administered to a patient with a creatinine level of 1.42 mg/dL, but requires careful monitoring of renal function, electrolytes, and clinical response. The benefits of treating volume overload often outweigh the risks, particularly when appropriate monitoring and dose adjustments are implemented.