From the Research
Bumetanide 2mg PO daily should be held if systolic blood pressure is less than 90 mmHg or if the patient experiences symptoms of hypotension such as dizziness, lightheadedness, or syncope, as recommended by general medical guidelines to prevent morbidity and mortality due to hypotension 1. When monitoring blood pressure in patients taking bumetanide, it is essential to consider the following parameters:
- Systolic blood pressure: hold the medication if less than 90 mmHg
- Symptoms of hypotension: dizziness, lightheadedness, or syncope
- Signs of dehydration
- Significant electrolyte abnormalities, particularly hypokalemia with potassium less than 3.0 mEq/L
- Acute kidney injury with a creatinine increase of more than 0.3 mg/dL from baseline Bumetanide is a potent loop diuretic that inhibits sodium and chloride reabsorption in the ascending loop of Henle, leading to increased urinary excretion of sodium, chloride, and water, which can cause significant blood pressure reduction through decreased intravascular volume 2, 3. The mechanism of action of bumetanide can lead to a rapid and marked diuresis, and increased urinary excretion of sodium, chloride, and other electrolytes, which persists for 3 to 6 hours 2. In patients with chronic renal failure or nephrotic syndrome, higher doses of bumetanide may be required, and muscle cramps are not uncommon, but glomerular filtration rates are unaffected 2. It is crucial to reassess the patient's volume status, blood pressure, and electrolytes before restarting bumetanide after holding it, to prevent further complications and ensure the patient's safety 1.