From the Guidelines
Yes, diuresis can occur with Intravenous (IV) fluid administration, as IV diuretics are commonly used to treat fluid overload in patients with heart failure 1.
Key Points
- IV loop diuretics, such as furosemide, bumetanide, and torsemide, are recommended for patients with heart failure admitted with evidence of significant fluid overload 1.
- The initial IV dose of loop diuretics should equal or exceed the patient's chronic oral daily dose and be given as either intermittent boluses or continuous infusion 1.
- Diuretic dose should be adjusted to relieve symptoms, reduce volume excess, and avoid hypotension 1.
- Combination therapy with two or more diuretics, such as a loop diuretic and a thiazide diuretic, may be used to enhance diuresis in patients who are resistant to diuresis 1.
- Continuous diuretic infusion may also be used to enhance diuresis, although the DOSE trial did not find a significant difference between continuous infusion and intermittent bolus strategies 1.
- Monitoring of urine output, electrolytes, and renal function is essential during IV diuretic therapy to avoid complications such as hypotension, renal dysfunction, and electrolyte disturbances 1.
- The goal of diuretic therapy is to achieve optimal volume status and relieve congestion without inducing an excessively rapid reduction in intravascular volume 1.
- Patients may require ongoing diuretic therapy after discharge to prevent recurrence of volume overload 1.
From the Research
Diuresis with Intravenous (IV) Fluid Administration
- Diuresis can occur with IV fluid administration, as evidenced by studies on IV diuretic therapy for heart failure and volume overload 2, 3, 4.
- IV diuretics can increase urine output and weight loss in patients with heart failure, with significant benefits across a wide range of maintenance diuretic doses and ejection fractions 2.
- The timing of IV diuretic administration can impact outcomes, with early initiation and modification of congestion treatment critical for prognostic improvement 3.
- Continuous infusion of loop diuretics can provide consistent urine flow, fewer alterations in fluid balances, and decreased dosage requirements, making it a therapeutic alternative for patients requiring diuresis 5.
- IV fluid administration can also be used to prevent contrast-induced nephropathy by correcting volume depletion and increasing urine output, but forced diuresis without adequate volume replacement can be deleterious 6.