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Dr. Andrew Rynne

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Is Lasix safe to have with low BP?

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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3611 Questions

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Posted on Thu, 2 Aug 2018 in Medicines and Side Effects
Question: My 87 year old mother is recovering at home from hospital acquired pneumonia after a turbt procedure three weeks ago. We had a seven day additional stay on IV antibiotics and were discharged Saturday.
She is also up a few lbs from target weight of 125lbs which is now 131.8
I just took her blood pressure it is 195/96 and heart rate of 71.
She is taking lasix losartin metoprolol sotolol eliquis for congestive heart failure and AFIB.
I am wondering if we need to go to ER or just administer an additional lasix to shed this extra fluid load.
We are scheduled for blood test at 10:30 in morning and visit with primary MD.
Am worried her BP will increase even more by morning as more fluid load will occur over nite before her morning lasix.

Just to clarify prescription drugs....taken at 10:30 AM Monday
Eliquis 2.5mg twice per day
Lasix 40mg once per day
Levothyroxine 100mcg tablet due to thyroidectomy fifty years ago
Losartan 100 mg once daily
Metoprolol succinate 25 mg once daily
Sotolo 80 mg once daily

I am wondering if we should be going to the ER or wait until morning....or take an additional lasix to shed fluid load.

We also had plural effusion with the pneumonia. The morning of the ER Visit eight days ago they administered 2000 ML fluids to bring up pressure and start flushing Sepsis. I asked that since her dry weight was already 134 and target weight was 125 perhaps the 2000 ml if fluids should be followed with lasix. They did not do it until that nite in hospital I noticed high respiration rate and asked for doctor...X-ray showed the pneumonia and plural effusion. Then they gave her 40 mg I'VE lasix and she shed 1500 ml urine in two hours. So I am worried with this extra fluid load and increased blood pressure we are needing extra lasix dose now.
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Answered by Dr. Panagiotis Zografakis 1 hour later
Brief Answer:
it depends on her clinical status

Detailed Answer:
Hello,

congestive heart failure is difficult to manage when another factor (like an infection) comes suddenly into play. I'm sure the doctors were right to administer intravenous fluids as this is the right treatment for severe sepsis. Lasix should be avoided when the blood pressure is low which I suppose happened in her case. Then the doctor has to watch the patient closely and act as necessary. There are some minimally invasive procedures to assist in this process like measurement of central venous pressure, etc but in most cases clinical assessment should be enough.

For a patient with congestive heart failure a systolic blood pressure as high as 195mmHg is too high and may exacerbate her heart failure. In such cases symptoms are expected like shortness of breath (new onset or worse than usual), swollen legs, etc. A doctor may notice auscultatory findings as well.

If she's handled this blood pressure well until now then perhaps you can try giving her some more lasix. Otherwise or if lasix does not normalize her blood pressure then a visit to the ER would be unavoidable. Before you do anything, make sure you've measured the blood pressure right. She has to be calm and sitting for 5-10 minutes and measure it at least twice to get the right pressure. The lowest values are considered more accurate. If - for example - the 1st measurement is 195/110 and the second (2-3 minutes later) is 160/90 then 160/90 would be more close to the real blood pressure than 195/110. In case the two measurements are that far apart a 3rd measurement might become necessary.

So in conclusion, her current clinical status is important to decide what to do next. If she's having shortness of breath then perhaps a doctor's assessment would be needed.

I hope it helps!
Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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