Steps, advance through levels if no response or rapidly deteriorating kidney function 

1. furosemide po qd/bid  at 0800, 1400

2. furosemide iv, same dose, qd/bid at 0800, 1400

3. furosemide bid, + metolazone at 0730

4. furosemide drip + metolazone at 0730
     Achieves good diuresis with lower total dose. 
     Start at 5mg/hr. 
     Can preserve kidney function.

5. furosemide + spironolactone

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The Compendium platform was created by David Kwinter, MD, CCFP(EM).