What is the recommended initial IV diuretic dose for a patient with acute decompensated heart failure?

In managing acute decompensated heart failure, the initial intravenous (IV) diuretic dose is crucial for effectively addressing fluid overload. The standard practice often involves the use of furosemide, as it is the most commonly utilized diuretic in this setting due to its well-established efficacy and safety profile.

Furosemide is generally dosed based on the patient's prior outpatient doses and their renal function. In many guideline recommendations, an initial IV dose starting at 20 to 40 mg is appropriate for most patients who are not currently on diuretics. For those who have been taking diuretics, such as furosemide, the initial dosing may escalate significantly.

While bumetanide and torsemide are effective diuretics, their standard initial dosing does not typically start as low as 1 mg or remain fixed at an equivalent of the discussed dosing for furosemide. Therefore, considering both the common practice and literature benchmarking, the most frequently referenced initial IV dose for the treatment of acute decompensated heart failure would align with the higher doses such as furosemide 80 mg or a similar quantity.

Recognizing these considerations, the most typical initial diuretic recommendation in acute decomp