2017 Volume 76 Issue 5 Pages 229-234
We experienced a case of loop diuretic resistance showing worsening systemic congestion and complaining of palpitation and dyspnea following overdosing with furosemide (120 mg/day), prescribed by a previous doctor, who was delivered to our hospital by ambulance. A 93-year-old woman was admitted to our hospital. The clinical diagnosis was severe congestive heart failure, based on dilated cardiomyopathy (DCM) accompanying anasarca, jugular venous distension, bilateral pleural effusion and pulmonary congestion on chest X-ray film and computed tomography. Left ventricular systolic function was remarkably deteriorated (EF; 33%) showing diffuse LV hypokinesia and reduced diastolic function (è; 3.7 cm/sec, E/è; 34). Critical volume retention was suspected due to dilated IVCD diameter (21 mm) and loss of respiratory collapsibility (< 50%) during echocardiography upon admission. From the first day after admission, the patient was treated with intravenous carperitide (0.5 μg/kg/min), furosemide 20 mg/day and potassium canrenonate 400 mg/day. From the 2nd day, tolvaptan 7.5 mg/day was administered. After 7 days, the intravenous furosemide and potassium canrenonate was changed to oral furosemide (20 mg/day) and spironolactone 100 mg/day. Carvedilol 5 mg/day and candesartan 2 mg/day were also administered from the 1st day. The combination of reducing the dose of furosemide (120 mg to 20 mg) and tolvaptan (7.5 mg/day) was effective for diuresis and resolution of the systematic severe congestion.
