I was making a joke that I don't personally use lasix drips.Maybe I misunderstood your post. Lasix gtt is not given one bolus at a time it's a 60,80 or 120 mg bolus followed by gtt stating at 5mg/hr and titrating up to 10 -15 mg / hr.
They do work though. Common circumstance that often happens is that there is a guy I have being diuresing with bolus doses and I intend to get 3 L negative. I have him a 60 mg or 80 bolus and then intend to come around to 1 or 2 pm and give another bolus if UOP isn't adequate. But then 4-5 admits pop up its a procedureorama and I am busy till 9 pm. I had no NP so if I didn't come back no one else would look at UOP. The nurse was lazy and never keeps an eye on the pt to remind me. Now it's 10 pm I am dead tired and I come back and pt is still 1 L positive for the day with all his various gtts/IV meds. Now even with another bolus he will still remain positive for the day.I was making a joke that I don't personally use lasix drips.
I can use them, but I usually just bolus because there is more data for that.
Yes that's true . But if you have been doing the boluses for 2 or 3 days i.e you were doing 40 mg BID on day 1 , 60 BID on day 2 and today you are thinking about 80 mg BID or TID maybe better to do a gtt and get a guaranteed negative. I also believe gtts cause less hypotension than intermittent boluses.or you could just schedule the second bolus for 2 pm and go do your admits? problem solved
Ummmm....you'll start a lasix drip at 40 and titrate up!?!? You'll give someone over a gram of lasix???Give 40. Start the drip at 40 per hour and nursung can titration the drip rate by 10 per hour up or down to a desired UOP per hour. Easy.
What I like about drips even though I don't use them regularly is that I can't take back a bolus. What I like about lasix is that it's not poison.
I am a big proponent of lasix gtt as compared to boluses but max I go is 20 mg/hr. By then you aren't getting the same bang for your buck and I would worry about ototoxicty especially as ICU hearing tests are kind of unreliable. Must people will pee on lasix 20/hr or bumex 1/hr if they have a creatinine < 3.5. I will be thinking about SCUF at that point.Hearing loss doesn't start until around 300mg per hour.
If they are making urine, they are making urine. First do no harm.
If they stop peeing, sure, but if it's going it's going. If it's needed it's needed.I am a big proponent of lasix gtt as compared to boluses but max I go is 20 mg/hr. By then you aren't getting the same bang for your buck and I would worry about ototoxicty especially as ICU hearing tests are kind of unreliable. Must people will pee on lasix 20/hr or bumex 1/hr if they have a creatinine < 3.5. I will be thinking about SCUF at that point.
I used to do a lot of CRRT and SLED but our nephrologists got territorial. I will put the lines in for them and while they control the machine they will let me run the UF rate.
I might have to use that... about the heartalysis....Usual scenario:
Me: Hm this guy is wet, maybe I'll increase Lasix boluses
cardio: Hey this guy is wet. I'm gonna start on bumex gtt
Me: er...ok. Doesn't that have worse renal outcomes?
cardio: The kidneys exist to purify blood for the pump. That's why there dialysis and no heartalysis.
Few days pass, now delta of serum Cr.>> pt weight loss. get renal consult
renal: why did you start drip? Don't you know...the wetter the better. Just give boluses.
leaves service...comes back in 5 days. pt ready for discharge. oof
It's just ATN and you suck.I might have to use that... about the heartalysis....
Also, no difference in renal outcomes with bolus vs drip (DOSE trial, NEJM... don 't quote me that garbage study from CC journal with <80 patients)
Personally, I don't care what the nephrologist has to say about filling pressures. I can't tell you how many times they have told me to give fluids because the guy is dry (FYI I have a ****ing swan in their neck and have full knowledge of their filling pressures- note a wedge of 30 is the opposite of dry). Those of you who are still in training will eventually realize that a good nephrologist who not only finds rare causes of renal failure but also will just orders dialysis when you want it is worth their weight in gold.