From the FDA Drug Label
Edema The usual initial dose of furosemide is 20 to 40 mg given as a single dose, injected intramuscularly or intravenously Furosemide is indicated in adults and pediatric patients for the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome
The workup for bilateral swollen feet in the ER may include the use of furosemide (IV), particularly if the swelling is due to edema associated with conditions such as congestive heart failure, cirrhosis of the liver, or renal disease. The initial dose of furosemide is typically 20 to 40 mg given as a single dose, injected intramuscularly or intravenously 1. However, the diagnosis and treatment of bilateral swollen feet should be individualized and based on the patient's specific condition and response to treatment.
- Key considerations include:
- Close medical supervision
- Laboratory monitoring
- Adjusting the dose based on the patient's response to gain maximal therapeutic effect and to determine the minimal dose needed to maintain that response 1.
From the Research
The workup for bilateral swollen feet in the emergency room should begin with a thorough history and physical examination to determine the underlying cause, as bilateral swelling often indicates a systemic cause such as heart failure, kidney disease, liver disease, or medication side effects, rather than a local issue. Initial assessment should include vital signs, cardiac examination, lung auscultation, and careful examination of the lower extremities for pitting edema, skin changes, and pulses. Some key points to consider in the workup include:
- Laboratory tests should include complete blood count, comprehensive metabolic panel (including kidney and liver function), urinalysis, and brain natriuretic peptide (BNP) if heart failure is suspected 2.
- Imaging studies may include chest X-ray to evaluate for pulmonary edema or pleural effusions, and lower extremity ultrasound if deep vein thrombosis is suspected 3.
- An ECG should be performed to assess for cardiac abnormalities. Management depends on the underlying cause - diuretics like furosemide 20-40mg IV may be given for heart failure (with close monitoring of kidney function), while elevation of the legs, compression stockings, and addressing the underlying cause would be appropriate for venous insufficiency. Severe cases with respiratory distress, hypoxia, or signs of cardiogenic shock require immediate intervention and possible admission for further management, as highlighted in the study by 2. It's also important to note that the differential diagnosis for bilateral swollen feet can be broad, including systemic illnesses such as heart failure, liver disease, malnutrition, and thyroid disorder; local conditions such as pelvic tumors, infection, trauma, and venous thrombosis; and various medications known to increase the risk of edema of the lower extremities, as discussed in the study by 4. However, the most recent and highest quality study 3 suggests that a thorough approach is required to recognize diseases and to avoid adverse drug events, particularly in older patients. In terms of specific management, the study by 2 highlights the importance of determining the cause of bilateral leg edema and providing correspondingly effective treatment, rather than simply prescribing diuretics. Overall, the key to managing bilateral swollen feet in the emergency room is to take a thorough and systematic approach to determining the underlying cause, and to provide management that is tailored to that cause.