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Difficulty: MediumPharmacological and Parenteral Therapies

A client hospitalized with acute heart failure exacerbation and severe pulmonary congestion receives a stat prescription for 80 mg of intravenous furosemide. The pharmacy provides the medication in vials with a concentration of 10 mg/mL. To prevent a known irreversible sensory complication associated with this therapy, which administration technique should be utilized?

  1. Administer the 8 mL dose continuously over a minimum of 4 minutes.Answer
  2. B
    Inject the medication rapidly over 60 seconds to expedite the clearance of pulmonary fluid.
  3. C
    Push the medication through a Y-site that is currently infusing a unit of packed red blood cells.
  4. D
    Withhold the administration until routine morning electrolyte levels are drawn and analyzed by the laboratory.

Answer

The safest technique is to administer the 8 mL dose continuously over a minimum of 4 minutes.
High doses of furosemide administered intravenously carry a significant risk of ototoxicity, which can cause permanent hearing loss. To mitigate this risk, standard pharmacological safety guidelines require the medication to be given at a rate no faster than 20 mg per minute. For an 80 mg dose, this requires a minimum administration time of 4 minutes.

Step-by-Step Solution

1
Identify the total dose and volume of the prescribed medication.
The dose is 80 mg. At a concentration of 10 mg/mL, the total volume to administer is 8 mL.
Accurate dose and volume calculation is a mandatory first step before determining the administration rate.
2
Determine the maximum safe intravenous administration rate for the medication.
High-dose furosemide should be administered at a maximum rate of 20 mg per minute.
Rapid administration of high-ceiling loop diuretics is directly linked to transient or permanent ototoxicity (hearing loss).
3
Calculate the minimum time required to safely push the medication.
Dividing the 80 mg dose by the maximum rate of 20 mg/minute yields a minimum safe administration time of 4 minutes.
This ensures the medication is delivered slowly enough to prevent acoustic nerve damage while still achieving therapeutic diuresis.

Key Concept

Intravenous furosemide must be administered slowly (not exceeding 20 mg/min for high doses) to prevent ototoxicity, and principles of safe parenteral therapy dictate verifying compatibility and prioritizing acute interventions.
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Topics

Pharmacological and Parenteral Therapies

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