Furosemide 40mg / Potassium chloride 600mg (potassium 8mmol) modified-release tablets

BackgroundSyndrome of inappropriate antidiuresis (SIAD) is a common cause of hyponatraemia, with fluid restriction (FR) failing in nearly half of patients. Although furosemide combined with oral sodium chloride (NaCl) tablets is widely used as second-line therapy, evidence supporting its effectiveness after FR failure remains limited, and predictors of response have not been established.MethodsThis prospective multicentre cohort study enrolled hospitalized adults with SIAD who failed FR at two tertiary centres in Thailand between October 2022 and September 2025. Patients received oral NaCl tablets (3.6 g daily) and furosemide (40 mg daily) while continuing FR. The primary outcome was the daily rate of serum sodium correction. Predictors of response were identified using multivariable linear mixed-effects models.ResultsAmong 88 patients (68% male; median age 65 years), the median baseline serum sodium was 124 mmol/l. Serum sodium increased by 1.51 mmol/l per day [95% confidence interval (CI) 1.37-1.66], reaching a median of 130 mmol/l by day 4 and 134 mmol/l by day 7. Three factors independently predicted faster correction: higher body weight (β 0.85 mmol/l per 10 kg; 95% CI 0.28-1.42), lower baseline sodium (β -0.58 per 1 mmol/l lower; 95% CI -0.77 to -0.39), and drug-induced aetiology (β 7.17 mmol/l; 95% CI 3.48-10.85). Adverse events included hypokalaemia (51%), hypomagnesaemia (29.5%), and acute kidney injury (18.2%). Overcorrection occurred in one (1.1%) patient.ConclusionsFurosemide combined with oral NaCl tablets is a practical second-line option for SIAD after FR failure, achieving sodium correction of 1.5 mmol/l per day. Higher body weight, lower baseline sodium, and drug-induced aetiology predict faster correction. Randomized controlled trials are needed to confirm efficacy.

Abstract licence: CC BY-NC

BackgroundWe assessed whether oral acetazolamide (ACZ) increases diuresis and reduces chloride loss when given alongside high-dose intravenous (IV) furosemide in patients admitted to hospital with HF.Methods and resultsADA-HF was a single-centre, open-label, randomised controlled trial. Patients were randomised to ACZ 250 mg twice daily plus high-dose (240 mg per day) IV furosemide infusion (standard of care (SoC)) versus SoC alone for 4 days. The co-primary endpoints were (1) daily net fluid loss between baseline and day 4 and (2) change in serum chloride level from baseline to day 4. A total of 46 patients (median age, 76; 65% male; median N-terminal pro-B-type natriuretic peptide, 4097 ng/L) from a screened population of 207 were randomised (23 to ACZ, 23 to SoC). The median daily net fluid loss was 1073 mL (1st-3rd quartile range 682-1419 mL) in the ACZ arm vs. 1029 mL (201-1432 mL) in the SoC arm (P = 0.51). There was no change in serum chloride concentration in the ACZ arm, whereas chloride fell by 7 (2-10) mmol/L in the SoC arm (P ConclusionsAcetazolamide has a significant "chloride-sparing" effect in patients given high-dose IV furosemide. However, ACZ did not significantly increase diuresis, and side effects from oral ACZ were frequent.Trial registrationISRCTN13060336; 9/2/2023.

Abstract licence: CC BY