Patients with heart failure are often admitted to the hospital because they have accumulated excessive amounts of fluid, they become short of breath and congested with fluid. Removing the excess fluid is necessary to improve the patients symptoms and reduce the risk of being re-admitted to the hospital. Diuretics ("water pills") are often given through an IV to accelerate the fluid removal. Furosemide is commonly used for fluid removal, however some patients do not respond well to the medication. There are other diuretics available that can work in conjunction with furosemide and increase the rate of fluid removal. The other "water pills" have slightly different mechanisms of action in the body compared to furosemide and when combined they may increase fluid removal. The investigators hypothesize that adding chlorothiazide to furosemide will result in quicker and more effective fluid removal in heart failure patients.
The investigators will randomly assign patients to receive either furosemide alone or furosemide in combination with chlorothiazide when they are admitted to the hospital with acute heart failure and excessive volume. All patients will be monitored for rate of fluid removal, improvement in symptoms, and side-effects of the medications.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Patients will receive lasix infusion starting at 5mg/hr along with a bolus dose of chlorothiazide 250mg at the initiation of the protocol. The lasix infusion can be titrated to 10mg after 12hrs based on volume of diuresis. This arm will also receive 250mg bolus doses of chlorothiazide every 12hrs for the duration of the study. Intravenous (IV) lasix infusion at 5mg/hr plus IV boluses of diuril every 12 hrs.
Patients will receive furosemide infusion at 5mg/hr along with an initial bolus dose of furosemide equal to twice their home oral dose. The furosemide infusion can be increased to 10mg/hr after 12hrs based on urine output. This arm will receive bolus doses of furosemide every 12hrs equal to twice their home oral dose until completion of the protocol.
Ochsner Heart and Vascular Institute
New Orleans, Louisiana, United States
Volume of Diuresis
Total volume of urine output will be collected during the first 72 hours of admission.
Time frame: During Index Hospitalization at 72 hours
Change in Serum Creatinine from Baseline
Change in serum creatinine from baseline after 72 hours of diuresis
Time frame: During Index Admission up to 120 hours
Hypokalemia
Time frame: From date of index hospitalization until 72 hours after diuresis
Electrolyte Disturbances
Magnesium, Phosphorous
Time frame: From date of index hospitalization until 72 hours after diuresis
Total Weight Loss
Time frame: From date of index hospitalization until 72 hours after diuresis
Relief of Symptoms
Using the five-point Likert scale for dyspnea which ranges from 1-5 where the lower the score the better the outcome
Time frame: From date of index hospitalization until 72 hours after diuresis
Length of Stay
Time frame: From date of index hospitalization until date of discharge from hospital, assessed up to 1 week
Potassium Replacement Requirements
Time frame: From date of index hospitalization until date of discharge from hospital, assessed up to 1 week
Adverse Events
Hypotension, dizziness, syncope, acute renal failure, arrhythmia
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Time frame: From date of index hospitalization until date of discharge from hospital, assessed up to 1 week