Abstract: PUB139
Shredding 35kg: The Dramatic Effect of Diuresis
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Ramzy, Silvia, Franciscan Health Olympia Fields, Olympia Fields, Illinois, United States
- Phan, Bernadette, Franciscan Health Olympia Fields, Olympia Fields, Illinois, United States
- Baggia, Aisha, Franciscan Health Olympia Fields, Olympia Fields, Illinois, United States
- Eldeeb, Kerolous, Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, Illinois, United States
- Soundararajan, Ramesh, Franciscan Health Olympia Fields, Olympia Fields, Illinois, United States
Introduction
Loop diuretics effectively relieve edema in heart failure and renal disease by promoting rapid fluid loss. A typical 1mg IV bumetanide dose yields 1-2kg of weight loss (~1-2L urine output). We present a 52-year-old male with an exceptional diuretic response, losing 35kg during hospitalization.
Case Description
A 52-year-old male with HTN, HFpEF 60%, and CKD IV presented with progressive dyspnea, 23kg weight gain over 5 weeks, and severe lower extremity and abdominal edema. Vitals were: BP 133/61, HR 67, RR 20, SpO2 84% on 5L NC, Wt 135.2kg. Labs were: HCO3 24, BUN 48, Cr 4.9, eGFR 13, serum osmo 313, BNP 794. CXR showed fluid overload; POCUS showed B-lines and distended IVC. He was started on BiPAP and admitted for acute decompensated heart failure (ADHF). Initial IV bumetanide 2mg BID was ineffective. Due to rising creatinine (peaked to 5.2), alkalosis requiring acetazolamide (HCO3 39), and persistent congestion, therapy was escalated to continuous IV bumetanide at 1 mg/h, targeting 3-4 L/day urine output. Over 3 days, urine output rose, Cr fell to 4.6, and CXR improved. The infusion was tapered to 0.5mg/hr for 2 days, then transitioned to IV then PO bumetanide 2mg BID. By discharge (day 12), weight was 100.3kg, Cr 2.9, and urine output >40L.
Discussion
ADHF is a common heart failure complication (~11.6 per 1000 persons aged ≥55), with ~5% in-hospital mortality. Renal dysfunction is a key prognostic marker; Cr ≥2.75 mg/dL and ≥5 kg weight gain worsen prognosis - both seen in our patient. Cardiorenal syndrome complicates treatment as venous congestion impairs renal perfusion and contributes to diuretic resistance. Despite CKD and initial IV diuretic resistance, the patient responded to continuous infusion. Aggressive diuresis led to a 35kg weight loss and symptom relief, with transient Cr rise from hemodynamic stress rather than structural injury. Renal function later improved. This case shows early intensive diuresis can be both effective and safe when closely monitored, even with initial worsening renal function.
UOP vs Weight