Furosemide Pediatric Dose — Diuretics
Furosemide is a loop diuretic that inhibits the Na⁺-K⁺-2Cl⁻ cotransporter in the ascending loop of Henle, promoting robust natriuresis and diuresis. It is one of the most widely used diuretics in pediatric practice, employed across a broad range of clinical settings including fluid overload, edematous states, and acute decompensated heart failure. Its availability in both intravenous and oral formulations makes it adaptable for inpatient and outpatient use in children of all ages.
Pediatric Dosing
- Intermittent Dose: 1 mg/kg/dose IV or PO
- Continuous Infusion: 0.05–0.4 mg/kg/hr IV, titrated to effect
The initial adult reference dose is 20 mg. Note that oral bioavailability is approximately 60% of the IV dose; when transitioning from IV to PO, dose adjustment should be considered to achieve equivalent effect.
Worked example: For a 20 kg child requiring an intermittent dose: 20 kg × 1 mg/kg = 20 mg per dose. For continuous infusion in the same child, the starting rate would be 20 × 0.05 mg/kg/hr = 1 mg/hr, titrated up to a maximum of 20 × 0.4 mg/kg/hr = 8 mg/hr based on response. Consult institutional protocol for maximum single and cumulative daily dose limits.
Indications and Clinical Context
Furosemide is indicated in pediatric patients with fluid overload, including conditions such as congestive heart failure, nephrotic syndrome, hepatic ascites, bronchopulmonary dysplasia, and postoperative fluid retention following cardiac surgery. It is a first-line diuretic agent in PICU settings where active decongestion is required and urine output must be closely titrated.
Continuous infusion may be preferred over intermittent bolus dosing when sustained, controlled diuresis is the goal, such as in critically ill patients with significant fluid overload or those requiring precise fluid balance management. Intermittent dosing remains appropriate for less acute settings. Standard pediatric and critical care guidelines support the use of furosemide across these indications, with dose individualized to the clinical response and hemodynamic status.
Administration and Monitoring
Furosemide may be administered intravenously (IV), intraosseously (IO), or orally (PO). When given IV, bolus doses are typically infused over 1–2 minutes; higher doses may warrant slower infusion over 15–30 minutes to reduce the risk of ototoxicity. Oral dosing must account for the approximately 60% bioavailability relative to IV administration. Continuous infusions should be prepared per institutional pharmacy protocols and delivered via a dedicated IV line or compatible lumen.
- Monitor: Urine output, fluid balance, serum electrolytes (potassium, sodium, magnesium), creatinine, and blood pressure
- Key adverse effects: Hypokalemia, hyponatremia, hypomagnesemia, hypochloremic metabolic alkalosis, dehydration, and ototoxicity (particularly at high doses or with rapid infusion)
- Contraindications: Anuria, known hypersensitivity to furosemide or sulfonamides; use with caution in patients with significant electrolyte depletion
- Consult institutional protocol for weight-based maximum doses and infusion concentration limits.
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.