الفهرس 
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Abstract
Objective: Comparing diuretic efficacy between high dose furosemide as a continuous infusion and bolus injections in children with congenital left to right shunts presenting with decompensated chronic heart failure.
Outcome measures: Diuretic efficacy of furosemide therapy assessed by net fluid output /40mg furosemide, change in Na/K ratio and change in body weight/40 mg furosemide in children with acute on top of chronic heart failure.
Patients and methods: The study included twenty six (26) patients, median age 0.75 years (range 0.42-1.2 years) with congenital left to right shunts presenting with normal ejection fraction heart failure. Two urine samples were collected from patients on admission and at day 3 of admission for immediate assay of urinaryNa and K.
Results: Thirteen patients (50%) were on continuous furosemide infusion versus thirteen (50%) that were kept on furosemide bolus injections. Patients on Furosemide infusion had significantly prolonged Capillary refill time and worse ROSS classification on admission and on follow up. On assessment of the diuretic response in the two groups we have found that patients on furosemide infusion had decreased Na/K ratio (P=0.017), increased furosemide dose (P=0.018), had less change in body weight(P=0.000) in relation to the diuretic dose and less fluid output (p=0.081).
Conclusion: Augmentation of furosemide therapy in the form of infusion rather than interval dosing in patients with heart failure is not always associated with an equivalent increase in diuresis and may not benefit the patient.
Key wards: Pediatric, heart failure, diuretic resistance, furosemide infusion
Abbreviations: ADHF: Acute Decompensated Heart Failure, CHF: chronic Heart Failure, CTR: Cardiothoracic Ratio, CXR: Chest x ray, HF: Heart Failure, K: Potassium, Na: Sodium, NYHA: New York Heart Association, SSPS: Statistical package for social science, UOP: Urine output.