DEPARTMENTAL POLICY AND PROCEDURE
Program:
University of Michigan Cardiovascular Center Pulmonary
Hypertension Program
Procedure Title:
Guidelines for Instituting and Following Diuretics in the
Pulmonary Hypertension Program
Procedure Written:
July 2011
Reviewed/ Revised: July 2011
Procedure Statement / Purpose: Oral diuresis in patients with chronic heart failure is
indicated for symptom management. Careful consideration of renal function needs to
be assessed in conjunction with any type of oral diuresis. Appropriate use of diuretics is
critical as unnecessarily high doses can increase risk of hypotension and renal
insufficiency and electrolyte imbalance.
Indications:
overload.
Physician decision to initiate loop diuretic in the setting of volume
Exclusions:
Patients with a history of hypersensitivity to loop diuretics.
Precautions: Patients with a history of sulfa allergy
Signs / Symptom Monitoring: Assess patients signs and symptoms and baseline
weight
Protocol:
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Check baseline Basic and BNP if current labs are more than 1 month old
Review and reinforce 2000 mg sodium restriction
Initiate 2L (64 ounce) fluid restriction
Initiate dose of diuretic as selected by physician.
Check Basic and BNP 1 week after initiating or changing dose of diuretic
o If Creatinine ≥ 1.5 mg/dl, or if Creatinine rises ≥ 0.5 mg/dl, then consult
physician
o If serum sodium < 125 mmol/l, then consult physician
Assess patients response to diuretic 3- days after initiation or changing dose of diuretic
MD Signature:
___________________________
Date: ____________
Val McLaughlin, MD
Medical Director, CVM Pulmonary Hypertension Program
Nurse Signature:
___________________________
Date: ____________
Janice Norville, MSN, MSBA, RN
Director of Clinical Operations – CVM – Special Programs