Why do we still use furosemide as our first line loop diuretic?
We currently have 3 loop diuretic options – furosemide (Lasix), bumetanide (Bumex) and torsamide (Demadex). They are all currently generic and available for 50 cents or less per pill.
In the 70s, during my residency I believe furosemide was already generic. The remaining two loop diuretics became available after my residency and thus had higher prices for several years.
Here is the problem. Furosemide is inconsistently absorbed across people and averages only 50% but for some people absorption is even less. Bumetanide and torsamide get absorbed consistently and close to 95%.
Several times this month we had pa...
Source: DB's Medical Rants - December 26, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Things that Bug me 1 – improper use of diuretics
This month on our VA ward team we have had 3 admissions that involved complications of over diuresis for systolic dysfunction. We also see patients who do not have adequate diuresis.
Diuretics greatly help symptoms in patients with systolic dysfunction and volume overload. But diuretics are primarily symptom relief medications.
I often ask students and residents to write this sentence, memorize it, and use it:
The purpose of diuretic therapy in systolic heart failure is render the patient not wet, but not to make the patient dry.
The idea here is that we should only give enough diuretic therapy to relieve symptoms. ...
Source: DB's Medical Rants - December 22, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Why do we still use oral furosemide?
Most physicians do not understand pharmacology and pharmacokinetics. We use Lasix (furosemide) because we have always used furosemide. As an academic hospitalist, we often have patients admitted with heart failure (either right sided or left sided) who have gained significant fluid weight despite taking significant oral doses of furosemide. When they get admitted we start with IV furosemide and amazingly they pee like racehorses.
How many of us remember that oral furosemide is variably absorbed, with a general range of 20%-80%? You may not remember that, or you might just be in the habit of using Lasix. Lasix has a gr...
Source: DB's Medical Rants - March 11, 2015 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Source Type: blogs
Upstream Problems
He had been through this before. The patient, a 57-year-old man, had come through the doors of this emergency department many times. He had a favorite seat in triage. He knew what questions the nurse would ask him once he was in a room, and that the doctor would repeat those same questions. Then tests and labs, then moved upstairs for a couple of days before going home, hopefully feeling better. He knew all of this. Today, though, everything he thought he knew was wrong.
He had once considered himself lucky. He even survived a gunshot to the chest as a young man. But that notion had faded long ago. His health had been get...
Source: Spontaneous Circulation - May 12, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Upstream Problems
He had been through this before. The patient, a 57-year-old man, had come through the doors of this emergency department many times. He had a favorite seat in triage. He knew what questions the nurse would ask him once he was in a room, and that the doctor would repeat those same questions. Then tests and labs, then moved upstairs for a couple of days before going home, hopefully feeling better. He knew all of this. Today, though, everything he thought he knew was wrong.
He had once considered himself lucky. He even survived a gunshot to the chest as a young man. But that notion had faded long ago. His health had been gett...
Source: Spontaneous Circulation - May 12, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
