Furosemide overdose
Furosemide (synonym Lasix) is one of the most powerful diuretics (diuretics). The drug is used more often as an emergency aid, it is systematically used only in the presence of pronounced congestion in the large, small, or both circles of blood circulation. The diuretic action of Furosemide is powerful, rapid and short-lived. After oral administration, the effect occurs in 15–30 minutes, reaches a maximum after 1–2 hours and lasts 6–8 hours. When administered intravenously, it appears after 5 minutes, peak - after 30 minutes, duration - 2 hours.
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Furosemide increases the excretion of water and, accordingly, the amount of urine excreted. Together with it, the drug intensively removes sodium, bicarbonates, phosphates, potassium, calcium and magnesium ions, which plays a fundamental role in the development of complications when therapeutic doses are exceeded.
The drug is available in the form of tablets (40 mg) and solution (10 mg / ml and 20 mg / 2 ml).
In the form of tablets, Furosemide is indicated for the following conditions:
- edematous syndrome of various etiologies, including chronic heart and renal failure, liver diseases;
- nephrotic syndrome;
- acute renal failure;
- severe arterial hypertension.
Parenteral administration (intravenously, rarely intramuscularly) Furosemide is indicated in the case of:
- edematous syndrome with decompensation of chronic heart failure stage IIA – III;
- acute heart failure (pulmonary edema, cardiac asthma);
- cirrhosis of the liver;
- swelling of the brain;
- eclampsia;
- severe arterial hypertension;
- hypertensive crisis;
- hypercalcemia;
- carrying out forced diuresis.
Contraindications or restrictions to the use of Furosemide are:
- conditions accompanied by a decrease in blood pressure;
- electrolyte imbalance;
- a pronounced violation of the outflow of urine of any etiology;
- acute myocardial infarction;
- severe diabetes mellitus;
- other diseases in the acute phase or in the stage of decompensation.
Furosemide penetrates the placental barrier, therefore it is contraindicated in pregnancy and is prescribed only if the benefits of using the drug for the mother are higher than the risk for the fetus. Since furosemide is excreted in breast milk, breastfeeding should be discontinued during treatment.
How much furosemide is needed for an overdose?
Furosemide is prescribed for adults and children over 3 years old, it is contraindicated for young children.
The initial dose for adult patients is 20–80 mg per day. It builds up gradually, is set individually in accordance with the clinical situation (diuretic response). The maximum daily dose is 1500 mg, divided into 2-3 doses. Maximum one-time (in exceptional cases) - 600 mg.
In children, the initial single dose is determined at the rate of 1–2 mg / kg of body weight per day with a possible increase in the dose to a maximum of 6 mg / kg per day, provided that the drug is taken no more than 6 hours later.
Changing the specified dosage regimen may lead to an overdose with symptoms of acute intoxication.
Signs of overdose
The main symptoms of a Furosemide overdose are:
- a pronounced decrease in blood pressure (blood pressure);
- feeling of unreasonable fatigue, drowsiness;
- dizziness, headache;
- decrease in body temperature;
- cooling and cyanotic staining of the skin;
- cold sweat, chills;
- dry mouth, intense thirst;
- a sharp decrease in the amount of urine separated, its concentrated color and pungent odor;
- confusion and depression of consciousness, apathy;
- heart rhythm disturbances;
- tachycardia;
- decreased muscle strength, hypo- or areflexia;
- nausea, vomiting, abdominal pain;
- convulsions.
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Sometimes you can find recommendations on the use of Furosemide for rapid weight loss - 3-5 kg in 2-4 days. The result of this practice can be severe electrolyte disturbances, heart rhythm disorders incompatible with life, collapse, shock, and, ultimately, death.
First aid for an overdose of Furosemide
In case of an overdose with parenteral use of the drug, you must immediately stop the administration, give the victim a position with an elevated foot end, provide fresh air by unbuttoning the tight clothing.
If there is an overdose of Furosemide tablets, you must:
- Rinse the stomach, for which drink 1–1.5 liters of warm water or a slightly pink solution of potassium permanganate and provoke an emetic urge by pressing on the root of the tongue.
- Take a saline laxative (magnesium sulfate).
- Take an enterosorbent (for example, Enterosgel, Atoxil according to the scheme or Activated Carbon at the rate of 1 tablet per 10 kg of body weight).
Antidote
There is no specific antidote for Furosemide.
When is medical attention required?
Medical assistance is needed if:
- a child, elderly person, or pregnant woman is injured;
- the victim is unconscious or has limited access to contact;
- BP is below 80/50 mm Hg. Art.;
- sharp tachycardia, arrhythmia;
- neurological symptoms (loss of orientation in time and place, lethargy or excessive agitation, convulsions, confusion, etc.);
- severe cyanosis of the skin and mucous membranes;
- intense shortness of breath, change in breathing;
- signs of dehydration;
- there are traces of blood in the vomit or stool.
If necessary, the injured by the ambulance team is delivered to the specialized department of the hospital, where further specific treatment is carried out:
- replenishment of circulating blood volume (Ringer's solution, isotonic sodium chloride solution, Polyglyukin, Reopoliglucin);
- artificial lung ventilation, oxygen therapy;
- intravenous administration of electrolyte solutions (sodium chloride, Lactasol, polarizing mixture);
- drugs to support the activity of the cardiac and respiratory system, if necessary;
- symptomatic therapy of developed disorders.
Possible consequences
The consequences of an overdose of Furosemide can be:
- acute renal failure;
- atrioventricular block;
- thromboembolism;
- collapse, shock;
- coma, death.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
