Furosemide
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Metabolic alkalosis and hypokalaemia in an elderly patient: case report A 68-year-old man experienced metabolic alkalosis and hypokalaemia while receiving furosemide. The man had been hospitalised to receive treatment for Enterococcus faecalis osteomyelitis. During his hospitalisation he had shown signs of volume overload and he had received intermittent doses of furosemide [dosages and routes not stated]. He subsequently developed overt signs of congestive heart failure, and he was given IV furosemide 40–80mg twice daily. Despite this, he continued to experience volume overload and he developed pulmonary oedema, requiring intubation during an episode of atrial fibrillation. He was transferred to an ICU, about 3 weeks after his initial hospitalisation; at the time of his transfer, he was receiving IV furosemide 80mg twice daily. He underwent diuresis with IV furosemide and his congestion gradually improved, but he developed progressive alkalemia and severe hypokalaemia over the next 5 days. He was diagnosed with metabolic alkalosis due to loop diuretic use and heart failure, and hypokalaemia due to loop diuretic use. The man received spironolactone and acetazolamide, and furosemide was withheld. His metabolic derangements showed improvement. He remained intubated due to a complicating pneumonia. He died 2 months later of ventilatorassociated pneumonia. Author comment: "[M]etabolic alkalosis due to heart failure and loop diuretic use; hypokalemia due to loop diuretic use and secondary hyperaldosteronism from decompensated heart failure." Peixoto AJ, et al. Treatment of severe metabolic alkalosis in a patient with congestive heart failure. American Journal of Kidney Diseases 61: 822-827, No. 5, May 2013. Available from: URL: http://dx.doi.org/10.1053/j.ajkd.2012.10.028 803087027 USA
0114-9954/10/1452-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 18 May 2013 No. 1452
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