Triple Diuretics and Aquaretic Strategy for Acute Decompensated Heart Failure due to Volume Overload

Table 1

Diuretics’ protocol: doses of furosemide and metolazone were titrated based on urine output; spironolactone dose was titrated to maintain a serum potassium of 4–4.5 mmol/L (mEq/L); tolvaptan dose was titrated to maintain a serum sodium of 131–139 mmol/L (mEq/L) (based on the initial value, maximum correction was 6–8 mmol/L (mEq/L) and not to exceed 139 mmol/L (mEq/L) in 24 hours).

Diuretics and suggested doses	Laboratory monitoring	Serum electrolyte goals	Target fluid loss
Furosemide: infusion 10–40 mg/hr	Serum chemistry every 6 hours	Sodium: 131–139 mmol/L (mEq/L)	4-5 liters/day
Spironolactone: 25 mg daily to 50 mg three times daily	Urine electrolytes every 6 hours	Potassium: 4–4.5 mmol/L (mEq/L)
Metolazone: 5 mg twice daily to 10 mg twice daily
Tolvaptan: 15 mg daily to 30 mg daily