this additional dose of IV furosemide. The medical resident stated that he needed the medication for his volume overload. I explained to the resident how much urine output the patient had since he was administered his initial dose of furosemide and how the patients heart rate was becoming elevated which could indicate the patient was becoming too systemically dry. The resident stated that he did not realize the patient had been given furosemide in the ED. He canceled the
medication. Through out the night the patient had orders for two more scheduled doses of IV furosemide all of which I had discontinued because the patient continued to have good urine output which by morning totaled almost 3 liters, and his heart rate was sustained between the high 90’s and 120’s sinus rhythm. In both patient scenarios I mentioned the age of these patients and their disease processes are the main factors that influenced the pharmacokinetic and pharmacodynamic process of furosemide. Furosemide is a loop diuretic that is metabolized first by the liver and then excreted through the kidney with its mechanism of action taking place in the part of the kidney known as the loop of Henle which is where water is prevented from being reabsorbed by the body and then excreted through the urinary tract (Rosenthal & Burchum, 2018). For the elderly population inappropriate and chronic use of furosemide can be associated with increased mortality, worsening renal function, electrolyte disorders, urinary urgency and incontinence, myocardial fibrosis, ototoxicity, osteoporosis and fractures, orthostatic hypotension and falls (Buttard et al., 2018).
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- Fall '13