Bumetanide

Bumetanide - A loop diuretic similar to furosemide but 40 times more potent. Ototoxicity may be less with bumetanide than with furosemide, but nephrotoxicity may be worse.

Uses:
Acute oliguric renal failure
May convert acute oliguric to non-oliguric renal failure. Other measures must be taken to ensure adequate circulating blood volume and renal perfusion pressure Pulmonary oedema secondary to acute left ventricular failure
Oedema associated with congestive cardiac failure, hepatic failure and renal disease

Contraindications:
Oliguria secondary to hypovolaemia

Administration:
• IV bolus: 1–2 mg 1–2 min, repeat in 2–3 h if needed
• IV infusion: 2–5 mg in 100 ml glucose 5% or sodium chloride 0.9% saline, given over 30–60 min

Adverse effects:
Hyponatraemia, hypokalaemia, hypomagnesaemia
Hyperuricaemia, hyperglycaemia
Hypovolaemia
Ototoxicity
Nephrotoxicity
Pancreatitis

Cautions:
Amphotericin (increased risk of hypokalaemia)
Aminoglycosides (increased nephrotoxicity and ototoxicity)
Digoxin toxicity (due to hypokalaemia)

Organ failure:
Renal: may need to increase dose for effect

Renal replacement therapy:
No further dose modification is required during renal replacement therapy