Intravenous moderate-dose bumetanide continuous infusion and severe musculoskeletal pain

We present a rare adverse side effect of moderate-to-high dose bumetanide continuous infusion in a 72year old Hispanic woman with a history of three-vessel coronary artery disease (CAD), heart failure (HF) with reduced ejection fraction, type 2 diabetes and stage III chronic kidney disease. The patient had been hospitalized for dyspnea and volume retention in the setting of progressive acute on chronic renal failure with oliguria. Trials of high-dose (160–240mg) fractionated bolus doses of intravenous furosemide were attempted in the first 48 to 72h with minimal urine output (10–20cm3/h). Metolazone was added to her regimen without appreciable incremental diuretic effect. She was then transitioned to bumetanide continuous infusion 1mg/h to augment diuresis. Within 12h of initiation, the patient reported diffuse multifocal “crampy” pain involving primarily her shoulder girdle, back and proximal lower extremities. Her symptoms persisted despite conservative pain control strategies including acetaminophen, ice/heat packs, narcotics and gabapentin. Her home medications (pravastatin, metoprolol succinate, amlodipine, aspirin, clopidogrel, doxazosin, isosorbide dinitrate, levothyroxine, insulin glargine) were continued without inpatient dosing changes. Serum creatine kinase was measured at 48units/L. Electrolyte disturbances including hyperphosphatemia in the background of her worsening renal function were considered as a cause of her symptoms, but no clinical improvement w...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Online Letters to the editor Source Type: research