Furosemide and Albumin for Diuresis of Edema: A Pilot Randomized Controlled Trial

Inclusion Criteria: * Hemodynamically stable for at least 24 hours (absence of persistent \[\>1 h\] hypotension \[systolic blood pressure \<90 mmHg), not currently on vasopressors, less than 2 L crystalloid or colloid boluses, or 2 units red blood cells administered, maintenance fluids excluded * Hypoproteinemia (serum albumin \<30 mg/L or total protein \< 60 mg/L) * Clinical decision to diurese at least 3 L net fluid balance within the next 72 hours for any reason Exclusion Criteria: * known pregnancy * patient or surrogate unable or unwilling to consent to blood product administration, including albumin * history of adverse reactions or allergy to either albumin or furosemide * acute kidney injury (RIFLE criteria "F" or greater) without any improvement in past 24 hours, or otherwise expected to necessitate dialysis within 48 hours in opinion of treating physician * chronic kidney injury requiring dialysis * clinically documented cirrhosis * clinically documented nephrotic syndrome * serum sodium greater than 150 milliequivalent/L or serum potassium less than 2.5 mEq/L that connote be treated prior to administration of study treatment * inability to measure urine output and fluid balance * Receipt of hyperoncotic albumin within preceding 24 hours * previous enrollment in this trial, or any research studies which may interfere with this study * estimated survival or ICU stay less than 72 hours