Cardiorenal Syndrome in Acute Heart Failure Syndromes

Table 1

Pharmacologic agents in the management of patients with AHFS.

Medication	Initial dose	Dose range	comments
Diuretics
Furosemide	20–80 mg IV bolus	20–400 mg boluses may repeat q6–8 H	Infusion is recommended at 5 to 40 mg/hr. If >240 mg/hr, risk of ototoxicity increases
Torsemide	10–40 mg bolus	20–200 mg bolus	Continuous infusion: 5–20 mg/hr
Bumetanide	0.5–2 mg bolus	0.5–4 mg bolus	Continuous infusion: 0.1–0.5 mg/hr
Vasodilators
Nitroprusside	0.3–0.5 𝜇g/kg/min	0.3–5 𝜇g/kg/min	Infusion rates of >10 𝜇g/kg/min may cause cyanide toxicity. Also, caution during active myocardial ischemia
Nitroglycerine	10–20 𝜇g/min	20–400 𝜇g/min	severe headache, hypotension, closed-angle glaucoma
Nesiritide	NO BOLUS	0.005–0.03 𝜇g/kg/min	Titration: increase infusion rate by 0.005 𝜇g/kg/min (no more than every 3 hr, up to a maximum of 0.03 𝜇g/kg/min)
Inotropes
Dopamine	2–5 𝜇g/kg/min	2–20 𝜇g/kg/min	May increase mortality. Caution for arrhythmia
Dobutamine	1-2 𝜇g/kg/min	1–20 𝜇g/kg/min	May increase mortality. Caution for arrhythmia
Milrinone	50 𝜇g/kg IV loading dose over 10 min; then 0.25–1.0 𝜇g/kg/min infusion	0.10–0.75 𝜇g/kg/min	May increase mortality. Caution for arrhythmia
Other
Levosimendan	0.05–0.2 𝜇g/kg/min bolus over 10 min followed by infusion	0.5–2.0 𝜇g/kg/min	May increase mortality. Not approved in the US. Caution for hepatic impairment and LV outflow obstruction