From the Research
Lasix (furosemide) should be held in patients with GI bleeding because it can potentially worsen the bleeding and complicate management. This is due to its mechanism of action as a loop diuretic, which reduces blood volume through increased urination, leading to decreased perfusion to vital organs including the gastrointestinal tract. In a GI bleed, this reduced perfusion may impair the body's ability to form clots and heal the bleeding site. Some key points to consider in the management of GI bleeding include:
- The initial evaluation of a patient with suspected upper gastrointestinal bleeding begins with assessment of hemodynamic status, identification of potential risk factors, and appropriate triage of level of care 1.
- Endoscopic evaluation can be performed to diagnose and potentially treat the source of bleeding, and risk factors that increase the propensity for recurrent bleeding should be identified and addressed 1.
- Additionally, Lasix can cause electrolyte abnormalities, particularly hypokalemia, which may affect cardiac function and complicate resuscitation efforts in patients who are already hemodynamically compromised from blood loss.
- The medication can also contribute to metabolic alkalosis, which shifts the oxygen-hemoglobin dissociation curve and potentially reduces oxygen delivery to tissues.
- Furthermore, Lasix may worsen renal function in the setting of volume depletion from bleeding, creating a dangerous cycle of worsening kidney function and fluid status, as seen in studies on fluid balance disorders and hemorrhage 2. Once the GI bleed is controlled and the patient is hemodynamically stable with normal or near-normal hemoglobin levels, Lasix therapy can be cautiously resumed if indicated for the patient's underlying condition. It is essential to prioritize the patient's hemodynamic stability and address any potential complications before resuming Lasix therapy, as guided by the latest evidence-based care for patients with acute upper gastrointestinal bleeding 3.