How do I write an order for a Lasix (furosemide) drip?

How to Write an Order for a Lasix (Furosemide) Drip

For patients requiring a continuous furosemide infusion, start with 20 mg bolus or 3 mg/h infusion (or last known effective dose), then double each subsequent dose until goal is achieved (oliguria reversal or target intravascular pressure) up to a maximum infusion rate of 24 mg/h or 160 mg bolus, not exceeding 620 mg/day. 1

Initial Assessment and Preparation

• Evaluate the patient's volume status, renal function, and electrolytes before initiating a Lasix drip 1
• Ensure proper IV access is established 1
• Place a urinary catheter to monitor urine output accurately 1

Components of a Furosemide Drip Order

1. Patient Identification:

   • Include full patient name, medical record number, and date of birth 1

2. Medication and Concentration:

   • Specify "Furosemide (Lasix) continuous IV infusion" 1
   • Standard concentration: 10 mg/mL (e.g., 100 mg in 10 mL) or 1 mg/mL (e.g., 100 mg in 100 mL) 1

3. Initial Dosing:

   • For new-onset heart failure or patients not on oral diuretics: 20-40 mg IV bolus followed by continuous infusion 1
   • For patients on chronic diuretic therapy: Initial IV dose should be at least equivalent to oral dose 1
   • Starting infusion rate: 3-5 mg/hour (typical starting dose) 1

4. Titration Parameters:

   • Include instructions for dose adjustments based on urine output 1
   • Example: "Double dose every 2 hours if urine output <0.5 mL/kg/hr until maximum rate of 24 mg/hour" 1
   • Maximum daily dose should not exceed 620 mg/day 1

5. Monitoring Requirements:

   • Specify "Monitor vital signs, urine output, renal function, and electrolytes every 4-6 hours" 1
   • Include parameters for when to notify the physician (e.g., "Notify if urine output <30 mL/hr for 2 consecutive hours") 1

6. Duration:

   • Specify the expected duration of therapy or parameters for reassessment 1

Sample Order

Furosemide (Lasix) continuous IV infusion
Concentration: 10 mg/mL (100 mg in 10 mL NS)
Initial rate: 5 mg/hour
Titration: If urine output <0.5 mL/kg/hr after 2 hours, increase by 5 mg/hour
Maximum rate: 24 mg/hour
Maximum daily dose: 620 mg
Monitor: Vital signs, I/O, daily weights, BUN/Cr, electrolytes q6h
Notify MD if: Urine output <30 mL/hr for 2 consecutive hours, K+ <3.0 mEq/L, 
         Cr increase >0.3 mg/dL, SBP <90 mmHg
Duration: Reassess in 24 hours

Special Considerations

• Electrolyte Management: Include orders for potassium replacement if needed 1
• Renal Function: Adjust dosing in patients with renal impairment 2
• Combination Therapy: In cases of diuretic resistance, consider adding thiazide diuretics (e.g., hydrochlorothiazide 25 mg PO) to enhance diuretic effect 1
• Fluid Balance: Include daily weight measurements and fluid restriction orders if appropriate 1

Potential Adverse Effects to Monitor

• Electrolyte imbalances (particularly hypokalemia, hyponatremia) 1
• Dehydration and hypovolemia 2
• Ototoxicity with high doses or rapid administration 2
• Worsening renal function 1

Alternative Approach for Diuretic-Resistant Patients

• For patients with diuretic resistance, continuous infusion has been shown to be more effective than intermittent bolus dosing 3
• Starting dose of 20 mg/hour, gradually increasing to a maximum of 160 mg/hour as needed 3
• This approach has demonstrated significant weight loss (mean 12.5 kg) and improved sodium excretion in patients with severe heart failure 3

Remember that furosemide is a potent diuretic that can lead to profound diuresis with water and electrolyte depletion if given in excessive amounts, requiring careful medical supervision and dose adjustments based on individual patient response 2.