If you are a nurse or doctor who is responsible for administering furosemide injection, it is important that you are familiar with the correct way to do so. This medication can be lifesaving in some cases, but it can also be dangerous if not administered properly. In this guide, we will discuss the proper way to administer furosemide injection and provide some helpful tips on how to ensure patient safety.

Uses for Lasix

Furosemide injections are a medical treatment that is used to treat fluid retention (edema) and swelling caused by congestive heart failure, liver disease (cirrhosis), kidney disease, or other medical problems.

Furosemide is a loop diuretic, or “water pill,” that works by increasing the flow of urine through the kidneys.

Only a doctor may give it. It should not be used at home unless strictly under medical advice.

Before using Lasix

The benefits of using a medicine must be weighed against the risks involved in taking it. This is a decision you and your doctor will make based on your particular circumstances. The following should be considered while making this decision:

Sulfonamide hypersensitivity, thiazide diuretic hypersensitivity

Furosemide should not be used in patients who are allergic to it. Because cross-sensitivity with furosemide has only been reported rarely, bumetanide can be used instead of furosemide in people who are allergic to furosemide. The likelihood of an adverse reaction from a loop diuretic in a patient with sulfonamide hypersensitivity or thiazide diuretic sensitivity is thought to be exceedingly low. Despite the fact that furosemide is a sulfonamide derivative, rare cases of sulfonamide cross-sensitivities have been documented.

In a patient who was subsequently skin-tested with furosemide, bumetanide, ethacrynic acid, chlorothiazide, and sulfamethoxazole-trimethoprim, an anaphylactic reaction to IV furosemide was documented in 1987. All but ethacrynic acid elicited a positive reaction. In a patient with sulfonamide sensitivity, hypersensitivity to both furosemide and bumetanide has been reported.

The FDA and the manufacturer of furosemide (Lasix) have never before received reports of cross-sensitivity between furosemide and sulfonamide antibiotics. Furosemide does not contain the N4-aromatic amine or the N1-substituent that are present in sulfonamide antibiotics. Loop diuretics, which contain non-arylamine sulfonamide derivatives such as acetazolamide, have been proposed to have a lower risk of allergic reactions in patients with sulfonamide allergy owing to their lack of an arylamine group at the N4 position (a structural site of action for sulfonamide allergy).

A large cohort study found that 9.9% of persons who had an allergic reaction after taking a sulfonamide antibiotic subsequently experienced an allergic response to a non-antibiotic sulfonamide derivative, whereas 1.6% of those who did not have an allergic reaction after taking a sulfonamide antibiotic responded badly to the same non-antibiotic sulfonamide derivative (adjusted odds ratio 2.8; 95% CI, 2.1—3.7).

There is no definitive evidence that a causal connection exists between sulfonamide hypersensitivity and non-arylamine sulfonamide analogs. Patients who have been diagnosed with a sulfonamide allergy are considered to be at risk for allergic drug reactions in general.

Acid/base imbalance, electrolyte imbalance, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, metabolic alkalosis

Before starting furosemide therapy, preexisting electrolyte imbalances, such as severe hyponatremia, hypokalemia, hypocalcemia, hypochloremia, or hypomagnesemia should be addressed. Loop diuretics can cause metabolic alkalosis and cause hypokalemia and hypochloremia; potassium chloride supplementation is effective in treating this acid/base imbalance.

Diabetes mellitus, hyperglycemia

During therapy with furosemide, blood and urine glucose levels should be evaluated in persons with diabetes mellitus or hyperglycemia. Loop diuretics can reduce glucose tolerance.

Diarrhea, heart failure, ventricular arrhythmias

Patients with ventricular arrhythmias, heart failure, potassium-losing nephropathy, aldosterone excess, or diarrhea should be closely observed since furosemide-induced hypokalemia can aggravate these problems.

Acute myocardial infarction

In individuals with acute myocardial infarction, excessive diuresis with furosemide should be avoided since it might induce shock.

Anuria, hypovolemia, renal disease, renal failure, renal impairment

The use of furosemide is not recommended for individuals with anuria. It should be used cautiously in any person with renal disease, including severe renal insufficiency or renal failure. In these individuals, drug-induced hypovolemia may cause azotemia. The presence of hypoproteinemia (e.g., nephrotic syndrome) may lessen the effects of furosemide and increase the risk of hearing damage.

The risk of ototoxicity may be increased when furosemide is given to patients with severe renal impairment. Furosemide is a potent diuretic that works for many people with renal insufficiency. Renal insufficiency can decrease the clearance and necessitate the use of higher dosages with longer dosing intervals. Furosemide may be less effective in these individuals, and delayed excretion of medication might raise the danger of toxicity.

Hypotension, orthostatic hypotension, sympathectomy, syncope

Before furosemide is given, patients with pre-existing hypovolemia or hypotension should have their condition corrected. Orthostatic hypotension can occur when loop diuretics are used. Syncope can result from excessive hypotension. Diuretic therapy’s antihypertensive properties may be enhanced in individuals who are prone to orthostatic dizziness, including the post-sympathectomy patient.

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Systemic lupus erythematosus (SLE)

Furosemide has been linked to the development of systemic lupus erythematosus (SLE), although the link is less certain than with procainamide or other medications.

Gout, hyperuricemia

Patients with gout or hyperuricemia who take furosemide may have disease exacerbations.

Hearing impairment

Ototoxicity can occur with high dosages or if furosemide is retained for an extended period of time. Ototoxicity can be induced by using furosemide incorrectly. When IV doses are given, do not exceed the advised rate of infusion.

Pancreatitis

Furosemide has been linked to the development of pancreatitis. It should be avoided by people who have had the previous pancreatitis.

Pregnancy

Furosemide should not be used during pregnancy unless the benefits outweigh the risks for the fetus. Because furosemide therapy can cause bigger birth weights, check on fetal development while you’re using it. There are no established studies of furosemide in pregnant women. Furosemides have been observed to result in inexplicable maternal fatalities and abortions in rabbits at 2, 4, and 8 times the maximum human dose.

Breast-feeding

When giving furosemide to a breastfeeding mother, use caution. Furosemide is excreted in human breast milk. In addition, furosemide may cause breast milk production to be suppressed as a result of severe diuresis. Chlorthalidone, chlorothiazide, and hydrochlorothiazide were previously considered acceptable by the American Academy of Pediatrics (AAP) in most cases when compared with other antihypertensive drugs.

Children, infants, neonates, premature neonates

In some prematurely born neonates that have been treated with furosemide for edema, nephrocalcinosis (calcium nephrolithiasis) has occurred. Nephrocalcinosis (calcium nephrolithiasis) has also been reported in infants and children under the age of four who do not have a history of prematurity and are taking chronic furosemide therapy. The usage of chlorothiazide has been reported to decrease hypercalciuria and dissolve some calculi when used concurrently.

Children with CHF who are receiving furosemide therapy should have their renal function monitored and renal ultrasonography performed. In addition, neonates that receive furosemide in the first few weeks of life may be at an increased risk of persistent patent ductus arteriosus.

Ascites, hepatic disease, hepatic encephalopathy

In patients with liver disease (i.e., hepatic cirrhosis), the manufacturer recommends starting furosemide therapy in the hospital. Patients with porphyria should not be treated for furosemide until their condition has improved. In patients with cirrhosis, rapid changes in fluid and serum electrolyte concentrations can trigger hepatic coma.

In persons taking furosemide, the chance of developing hypokalemia is increased if cirrhosis is present. Potassium supplementation and, as needed, an aldosterone antagonist can help to prevent hypokalemia and metabolic alkalosis.

Prostatic hypertrophy, urethral stricture, urinary retention

Furosemide, when given to persons with severe bladder retention (due to bladder emptying disorders, prostatic hypertrophy, urethral stricture) signs and symptoms of acute urinary retention can be produced. This is due to an increase in urine production and retention. Keep a close eye on these individuals, especially during the start of furosemide therapy.

Thyroid disease

Thyroid disease should be considered when using high dosages (more than 80 mg) of furosemide cautiously. Furosemide has the potential to impair the thyroid hormones’ binding to carrier proteins at higher doses, resulting in a brief rise in free thyroid hormones followed by an overall decrease in total thyroid hormone levels.

Geriatric

In geriatric patients, greater sensitivity to the hypotensive and diuretic effects of furosemide is possible. There were no significant differences in responses between the older adult and younger adult patients in published clinical experience. In general, elderly patients should be treated with caution, usually starting at the lower end of the dosing range. Furosemide is excreted largely by the kidney, which may contribute to toxic reactions in these people.

The elderly are more prone to have reduced renal function, therefore dosage selection should be cautious and monitoring of renal function may be beneficial. Diuretics are classified as potentially inappropriate medicines (PIMs) in the elderly and should be used cautiously owing to the risk of causing or aggravating SIADH or hyponatremia. When administering or changing dosages of diuretics in older persons, careful monitoring of sodium levels is required.

The federal Omnibus Budget Reconciliation Act (OBRA) governs the use of medications in long-term care facilities; antihypertensive therapies should be customized to achieve the intended result while avoiding adverse effects. Dizziness, postural hypotension, tiredness, and falls are all possible side effects of antihypertensives. In addition, diuretics may cause fluid and electrolyte imbalances as well as exacerbate urinary incontinence. Furosemide has anticholinergic properties that might be hazardous in the elderly.

Dosage for Lasix

Your doctor will determine the appropriate dose of furosemide injection for you. In general, furosemide injections are given as a slow intravenous infusion over at least 60 minutes.

If an immediate effect is desired, furosemide can also be given by bolus injection (a single rapid injection). The usual dosage range for adults is 20 to 80 mg administered intravenously or intra-arterially. Dosages should be reduced in patients with renal impairment.

Side effects of Lasix

The common side effects of furosemide are due to its diuretic (water-removing) effect. These include:

  • Dizziness
  • Lightheadedness
  • Weakness
  • Nausea and vomiting
  • Loss of appetite
  • Diarrhea or constipation
  • Headache
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Changes in blood pressure may cause dizziness or fainting upon standing up, especially when you first start taking this medication or if your dosage is increased too rapidly. If any of these symptoms occur, tell your doctor immediately. You should also seek medical attention if you experience shortness of breath, rapid weight gain, unusual swelling around the ankles or feet, chest pain, persistent dry cough, or fainting.

Less common side effects that may require medical attention include:

  • Sensitivity to sunlight
  • Urinary tract infection
  • Liver problems
  • Joint pain
  • Impaired hearing
  • Changes in blood sugar levels (hypoglycemia) or increased blood potassium levels (hyperkalemia)
  • Allergic reaction
  • Rashes, itching or hives in the skin

Swelling of the face, lips, tongue, and throat (angioedema) – rarely this can be life-threatening. This condition may result from furosemide’s effect on blood vessels that dilate abnormally. If you experience any of these symptoms, contact your doctor immediately.

Less common furosemide side effects that may require medical attention include:

Increased cholesterol levels in the blood (hypercholesterolemia) or increased triglycerides in the blood (hypertriglyceridemia). These conditions can increase your risk of developing heart disease and stroke.

Increased uric acid levels in the blood (hyperuricemia). Uric acid is a waste product that can build up in your body and cause joint pain or kidney stones. furosemide may increase the risk of gout attacks because it increases how much uric acid is excreted by the kidneys.

Precautions while using Lasix

It’s critical that your doctor check you or your kid carefully while you’re taking this medicine. This is to ensure that the medication is effective. Blood or urine tests may be required to detect any adverse effects.

While you are pregnant, using this medicine may cause your unborn youngster to be larger than usual. If you believe you’re pregnant while taking this medication, contact your doctor immediately.

Your or your kid’s potassium levels may drop even more than usual (hypokalemia) as a result of this medicine. This is more probable if you have liver disease (cirrhosis), or if you’re taking this medicine with steroids (cortisone-like medicines), adrenocorticotropic hormone (ACTH), licorice in large amounts, or laxatives for a long time.

If you experience severe or continuing nausea, vomiting, or diarrhea and replace fluids as needed to avoid dehydration. If you have any of the following symptoms: dry mouth; increased thirst; muscular cramps; or nausea or vomiting, get help right away from your doctor:

If you or your child develop a sudden loss of hearing or dizziness, stop taking this medicine and see your doctor immediately. You may experience vertigo or ringing in the ears if you have a hearing problem. If you are dizzy or lightheaded, discuss any tingling sensations; feeling as though everything is spinning, or a sense of whirling.

Dizziness, lightheadedness or fainting may occur when you get up quickly from a prone or seated position. Getting up gradually might aid in the alleviation of symptoms. If the problem persists or gets worse, see your doctor.

This drug might cause blood sugar levels to rise. If you or your child has diabetes and sees an alteration in the results of his/her blood or urine sugar tests, speak with your doctor.

This medication might make your skin more sensitive to sunlight. When outdoors, apply a sunblock, hat, and clothing that protects you from the sun. Sunlamps and tanning beds should be avoided.

Make sure any doctor or dentist who looks at you knows that you are using this therapy. This medicine may have an impact on the outcome of certain medical tests.

Do not use over-the-counter medicines, prescription or nonprescription (over-the-counter), unless your doctor has told you to do so. This includes appetite suppressants, asthma inhalers, cold treatments, cough medicines, hay fever drugs, or allergy medications.

Furosemide therapy

normal renal function

Furosemide is a loop diuretic that is used to treat fluid retention and edema. It is also used to manage high blood pressure and heart failure. Furosemide works by increasing the amount of urine that the kidneys produce. This medication comes in tablet, capsule, and injection form.

When taking furosemide, it is important to drink plenty of fluids. You should also avoid sun exposure, and use sunscreen if you must be outside. If you are taking this medication for high blood pressure, it is important to monitor your blood pressure regularly. Furosemide can cause your blood pressure to drop too low. This can cause dizziness and fainting. If you experience any of these symptoms, contact your doctor immediately.

Furosemide may increase the risk of gout attacks because it increases how much uric acid is excreted by the kidneys. Furosemide also causes a decrease in blood potassium levels (hypokalemia). Hypokalemia can result in muscle weakness and abnormal heart rhythms. You should avoid becoming dehydrated while taking this medicine as dehydration will worsen side effects such as dizziness or lightheadedness. Talk to your doctor before using salt substitutes that contain potassium or supplements if you are taking furosemide for high blood pressure or congestive heart failure so they can monitor your electrolyte levels.

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Furosemide is available in tablet, capsule, and injection form. It is usually taken once or twice a day with food. The effect of the drug can be felt one to two hours after ingestion. If you miss a dose, take it as soon as possible if there are at least four hours until your next scheduled dose; otherwise, skip this dose entirely and resume the normal dosing schedule. Do not double up on doses to make up for missed ones: instead, talk with your doctor about how best to handle this situation or what alternative treatment options might work better for you.

Congestive heart failure

Congestive heart failure is a condition in which the heart can no longer pump blood efficiently. This leads to fluid buildup around organs and tissues throughout your body because there’s less pressure from within the arteries that supply them with nutrients, oxygenated blood, and other substances needed for their proper functioning. The main cause of this problem is atherosclerosis: hardening or narrowing caused by deposits inside artery walls as time passes over years without treatment or lifestyle changes such as exercise/diet modification-which could have prevented it entirely (if done soon enough). If detected early on before damage occurs then intervention strategies include bypass surgery where part of an unaffected vessel replaces one that has become blocked due to plaque build up (see figure below). However, when congestive heart failure has progressed significantly and other organs are also involved (such as kidneys), then a transplant may be the only solution.

Congestive heart failure symptoms:

  • Shortness of breath, especially during physical activity or while lying down
  • Swelling in feet, ankles, legs-due to fluid accumulation
  • Rapid weight gain due to fluid retention
  • Fatigue and weakness
  • Irregular heartbeat (arrhythmia) or palpitations
  • Nausea and vomiting
  • Diabetes mellitus or kidney problems secondary to congestive heart failure

Figure: Diagram illustrating blocked artery leading to reduced blood flow and damage downstream including congestion of the liver (hepatomegaly) and swelling in the brain (encephalopathy).

Treatment options include beta-blockers, ACE inhibitors, and/or angiotensin II receptor antagonists (ARBs) which reduce pressure in your blood vessels. There are also other medications such as furosemide that work by removing excess fluid from the body through urination while preventing potassium loss. If diet modifications alone aren’t enough then surgery may be necessary depending on where exactly it is located within one’s heart chambers (i.e., if someone has a hole between their left ventricle & right atrium then this would require an opening repair operation rather than bypass grafting because no external vessel exists for replacing what is blocked internally).

FAQ

When do you give Lasix injections?

Furosemide is given by injection to patients with congestive heart failure who have fluid buildup (edema). It helps remove excess water from the body. The dosage and how often you receive this medication will depend on your medical condition and response to treatment. Your doctor may adjust your dose if needed until the desired effect occurs or side effects.

How long does it take for the Lasix injection to work?

Furosemide begins working within one to two hours after you take it. It is important to follow your doctor’s instructions for taking this medication. If you miss a dose, take it as soon as possible if there are at least four hours until your next scheduled dose; otherwise, skip this dose and resume the normal dosing schedule.

Where do you inject Lasix IM?

The furosemide injection is given into a muscle (IM). You will be taught how to give the injection by your healthcare provider. Do not give yourself this medication unless you have been instructed to do so.

How do you administer a furosemide injection?

Furosemide can be given by mouth or injected directly into a vein (IV), muscle injection, skin patch, and rectal enema. The furosemide injection is usually given as needed to treat fluid buildup in heart failure patients.

Can diuretics be injected?

Yes, diuretics can be injected. Furosemide is a type of diuretic that is given by injection to patients with congestive heart failure who have fluid buildup (edema). It helps remove excess water from the body. The dosage and how often you receive this medication will depend on your medical condition and response to treatment.

Conclusion thoughts

Furosemide is given by injection to patients with congestive heart failure who have fluid buildup (edema). It helps remove excess water from the body. The dosage and how often you receive this medication will depend on your medical condition and response to treatment. Your doctor may adjust your dose if needed until the desired effect occurs or side effects. Furosemide begins working within one to two hours after you take it. It’s important that furosemide be taken as instructed; otherwise, skip this dose and resume the normal dosing schedule. You should not give yourself this medication unless directed by a healthcare provider because of its potential adverse reactions like stomach upset, nausea, vomiting, diarrhea, headache, dizziness, or lightheadedness.

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