Furosemide

• Pulmonary oedema in severe pre-eclampsia
• Peripartum cardiomyopathy with congestion
• Postpartum fluid overload

Blocks Na⁺/K⁺/2Cl⁻ transporter in thick ascending limb → potent natriuresis and diuresis.

• Do NOT use for physiological oedema
• Watch K⁺ + Mg²⁺
• IV onset 5 min, oral 30–60 min

IV bolus

20–40 mg (double if no response in 30 min)

IV infusion

5–10 mg/h

• AbsoluteAnuric renal failure
• AbsoluteSulfonamide hypersensitivity (rare cross-reactivity)
• CautionUncomplicated pre-eclampsia (reduces intravascular volume)

• Hypokalaemia, hypomagnesaemia, hypocalcaemia
• Hyperuricaemia, hyperglycaemia
• Ototoxicity (fast IV push)
• Metabolic alkalosis

• • Not teratogenic but ↓ maternal intravascular volume can compromise uteroplacental perfusion — reserve for true overload

• Aminoglycosides

  Avoid

  Additive ototoxicity

• Digoxin

  Caution

  Hypokalaemia potentiates toxicity

• NSAIDs

  Caution

  ↓ diuretic effect

• 💡 Push IV over ≥1–2 minutes to reduce ototoxicity
• 💡 Replace K⁺ and Mg²⁺ aggressively