Approach to Diuresis

(if inadequate diuresis, go to next step)

• Loop diuretic PO:
  • ✓ response at ↣ 1-3 h,
  • redose at ↣ 2× prior dose if needed
• Add thiazide diuretic PO (potentiates response to loop diuretic)
• Loop diuretic IV:
  • bolus bid-qid ± thiazide (may start here if inPt) ↑ dose w/ ↑ Cr;
  • initial effective IV Lasix dose ≈ 30 × Cr
    • (ie, if Cr = 4 → 120 mg IV)
• Loop diuretic infusion:
  • bolus + continuous IV infusion ± thiazide (PO or IV)
• RRT:
  • consider ultrafiltration,
  • CRRT,
  • HD