From the FDA Drug Label
If the physician elects to use high dose parenteral therapy, add the furosemide to either Sodium Chloride Injection USP, Lactated Ringer's Injection USP, or Dextrose (5%) Injection USP after pH has been adjusted to above 5. 5, and administer as a controlled intravenous infusion at a rate not greater than 4 mg/min. If the physician elects to use high dose parenteral therapy, controlled intravenous infusion is advisable (for adults, an infusion rate not exceeding 4 mg furosemide per minute has been used)
The rate at which IV Lasix (furosemide) should be administered in hyponatremia with heart failure is not greater than 4 mg/min as a controlled intravenous infusion for high dose parenteral therapy 1 1.
From the Research
The recommended rate for IV Lasix (furosemide) administration in hyponatremia with heart failure is typically 5 mg/hour, as seen in the study by 2, which compared a tolvaptan-based vs. furosemide-based diuretic regimen on short-term clinical responses in hyponatremic acute heart failure.
Key Considerations
- The initial dose of furosemide can be given as a slow IV push over 1-2 minutes for immediate treatment, but for continuous infusions, the rate should be individualized based on the patient's renal function, severity of hyponatremia, and clinical response.
- Careful monitoring of electrolytes (especially sodium, potassium, and magnesium), fluid status, blood pressure, and renal function is essential when administering Lasix.
- The goal is to achieve a gradual correction of sodium levels (not exceeding 8-10 mEq/L in 24 hours) to avoid osmotic demyelination syndrome.
- Lasix works by inhibiting sodium and chloride reabsorption in the loop of Henle, promoting diuresis and helping to manage fluid overload in heart failure while potentially improving hyponatremia by reducing total body water.
Additional Factors
- High doses of furosemide and spironolactone, or concomitant use of these diuretics, seem to be an important cause of hyponatremia in HF patients, particularly in combination with advanced age, diabetes, and alcohol consumption, as noted in the study by 3.
- The use of tolvaptan, a selective V(2)-receptor antagonist, may be beneficial in correcting serum sodium in patients with euvolemic/hypervolemic hyponatremia, including HF, as seen in the study by 4.
- However, the most recent and highest quality study, 2, provides the most relevant guidance for the administration of IV Lasix in hyponatremia with heart failure.