Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: Long-term effects

Licata, Giuseppe; Pasquale, Pietro Di; Parrinello, Giovanni; Cardinale, A; Scandurra, A.; Follone, G; Argano, Christiano; Tuttolomondo, Antonino; Paterna, Salvatore

doi:10.1067/mhj.2003.166

Cited by 235 publications

(195 citation statements)

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“…100 A recent clinical study reinforced this idea by demonstrating that correction of serum [Na ϩ ] using hypertonic saline infusions was associated with improved outcomes in a group of patients with advanced CHF. 101 Current conventional recommendations for treatment of hyponatremia in specific disorders associated with hypervolemia are given below (also see "Vasopressin Receptor Antagonists" for details on how these recommendations may change with increasing experience using these new agents).…”

Section: Hypervolemic Hyponatremiamentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

523

498

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Although hyponatremia is a common, usually mild, and relatively asymptomatic disorder of electrolytes, acute severe hyponatremia can cause substantial morbidity and mortality, particularly in patients with concomitant disease. In addition, overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death, and optimal treatment strategies for such cases are not established. Hyponatremia is the most common disorder of electrolytes encountered in clinical practice, occurring in up to 15% to 30% of both acutely and chronically hospitalized patients. 1 Although most cases are mild and relatively asymptomatic, hyponatremia is important clinically because: (1) acute severe hyponatremia can cause substantial morbidity and mortality; (2) mortality is higher in patients with hyponatremia who have a wide range of underlying diseases; and (3) overly rapid correction of chronic hyponatremia can cause severe neurologic deficits and death.Despite knowledge of hyponatremia since the mid-20th century, this common disorder remains incompletely understood in many basic areas because of its association with a plethora of underlying disease states, and its multiple etiologies with differing pathophysiologic mechanisms. 2 Optimal treatment strategies have not been well defined, both for these reasons and because of marked differences in symptomatology and clinical outcomes based on the acuteness or chronicity of the hyponatremia. 3 Vasopressin receptor antagonists have long been anticipated as a more effective method to treat hyponatremia by virtue of their unique aquaretic effect to selectively increase solute-free water excretion by the kidneys. 4 The recent approval of the first such agent, conivaptan, for clinical use by the US Food and Drug Administration (FDA) heralds the beginning of a new era in the management of hyponatremic disorders. However, effective therapy with these agents will require intelligent guidelines for their use. To this end, a panel of experts in hyponatremia convened to review current therapies for hyponatremia and to evaluate the situations in which aquaretic agents should be considered as alternatives or supplements to accepted current therapies. This review is a summary of the conclusions of this panel.

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Section: Hypervolemic Hyponatremiamentioning

confidence: 99%

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Verbalis

Goldsmith

Greenberg

et al. 2007

The American Journal of Medicine

523

498

View full text Add to dashboard Cite

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“…17 In a randomized single-blind study on 107 patients with refractory HF, Licata et al used intravenous (IV) furosemide combined with small volumes of hypertonic saline, and compared the results with those of patients who received only IV furosemide. 18 While the first group showed significant improvement in their hyponatremia (increase in serum Na from 135.8 to 142.3 mEq/L, P < 0.001), serum Na levels decreased in those patients who received furosemide alone (134.8 to 130.2 mEq/L, P < 0.007). Importantly, use of hypertonic saline was not associated with increased congestion and change in HF functional class.…”

Section: Newer Management Strategymentioning

confidence: 87%

Hyponatremia in Heart Failure: Revisiting Pathophysiology and Therapeutic Strategies

Kazory

2010

Clinical Cardiology

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Hyponatremia is frequently encountered in patients with heart failure (HF), and its association with adverse outcomes is well-established in this population. While hyponatremia is an independent marker for severity of HF, it is not certain whether it has a causal impact on the progression of the disease. There are no universally accepted consensus guidelines regarding therapeutic strategies for HF-associated hyponatremia and volume overload; current societal guidelines do not address management of this complication. Whereas thiazide diuretics are known to induce or worsen hyponatremia in this setting through a number of mechanisms, loop diuretics can be considered a readily available first-line pharmacologic therapy. Consistent with pathophysiology of the disease and mechanisms of action of loop diuretics, available clinical evidence supports such an approach provided that patients can be closely monitored. Use of vasopressin receptor antagonists is an emerging therapeutic strategy in this setting, and the efficacy of these agents has so far been shown in a number of clinical studies. These agents can be reserved for patients with HF in whom initial appropriate loop diuretic therapy fails to improve serum sodium levels. Scope of the ProblemHyponatremia, the most common electrolyte abnormality in hospitalized patients, is associated with increasing morbidity and mortality in various clinical settings, including heart failure (HF). In an analysis of the Organized Program To Initiate Life-Saving Treatment In Hospitalized Patients With Heart Failure (OPTIMIZE-HF) study comprising data on 47 647 admissions for acute decompensated HF (ADHF), 19.7% of the patients presented with hyponatremia, defined as a serum sodium (Na) level <135 mEq/L.1 This subgroup of patients demonstrated significantly worse outcomes and was more likely to require dialysis and inotropic agents. The in-hospital mortality rate was also significantly higher compared with those patients with normal serum Na levels (6% vs 3.2%, P < 0.0001). Nearly half of the study population had preserved left ventricular ejection fraction (LVEF), suggestingthat presence of hyponatremiais an independent predictor of outcomes in HF patients with both preserved as well as reduced LVEF, a concept that has been confirmed by other authors. 2,3 In another study on more than 4000 patients, Lee et al demonstrated that chronic hyponatremia (defined as serum Na level <136 mEq/L) increased the 30-day mortality by 53% and the 1-year mortality by 46% in patients admitted with a primary diagnosis of HF. 4 In addition to its impact on survival, in a study on patients withThe author is a consultant for Otsuka America Pharmaceutical, Inc. The author has no other funding, financial relationships, or conflicts of interest to disclose. a discharge diagnosis of HF in 49 US academic medical centers, hyponatremia was shown to significantly increase the hospital length of stay. 5 HF being the most common reason for hospitalization in patients age >65 years, and with an annual cost exceedi...

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“…The concentrations of NaCl, KCl, and MgSO4 were 2.8%, 0.2%, and 0.9% respectively. In this study, the patients received ACE inhibitors, digitalis, and nitrates as in previous studies, [5][6][7][8] as well as oral KCl supplementation. The treatment was continued after discharge.…”

Section: Methodsmentioning

confidence: 99%

Impact of Compound Hypertonic Saline Solution on Decompensated Heart Failure

Yue

Niu

et al. 2017

Int. Heart J.

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SummaryThe aim of the present study was to evaluate the effects of hypertonic saline solution (C-HSS) with high dose furosemide on hospitalization time, readmission, and mortality in patients with New York Heart Association (NYHA) class III heart failure.Decompensated heart failure patients (NYHA III) with chronic ischemic or nonischemic cardiomyopathy and ejection fraction < 40% were divided into 2 groups in an open-label random manner: the first group received a 1-hour intravenous infusion of furosemide (100 mg) plus compound C-HSS (100 mL) twice daily and underwent serious water restriction (500 mL/day); the second group received furosemide intravenous bolus (100 mg) twice a day and water restriction (500 mL/day), without C-HSS. Both groups had normal sodium (120 mmol sodium) intake. After discharge, the two groups continued to receive 120 mmol Na/day and 500-1000 mL water/day.The first group (132 C-HSS patients) had an increase in urination, a reduction in hospitalization time (4 ± 2 versus 7 ± 2 days, P < 0.01), and a reduction in hospitalization costs (2210 RMB versus 3506 RMB, P < 0.01) compared with the second group (132 without C-HSS patients). During the follow-up period (36 ± 12 months), the first group had a significantly higher average readmission time (31.84 ± 7.58 months versus 15.60 ± 6.25 months, P < 0.01) and lower mortality rate (16.5% versus 31.9%, P < 0.01).The results suggest that periodical C-HSS administration, combined with serious water restriction and a normal sodium diet, significantly reduces the hospitalization time, readmission rate, and mortality in patients with NYHA class III HF. (Int Heart J 2017; 58: 601-607)

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Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: Long-term effects

Cited by 235 publications

References 0 publications

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

Hyponatremia in Heart Failure: Revisiting Pathophysiology and Therapeutic Strategies

Impact of Compound Hypertonic Saline Solution on Decompensated Heart Failure

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