Regulate dose carefully to prevent a more rapid or substantial loss of fluid or electrolytes than is indicated or necessary. Diuresis and natriuresis are dependent on the degree of fluid accumulation in the patient. Potassium excretion is determined in large measure by the presence and magnitude of aldosteronism.
0.5 to 1 mg/kg of body weight. 50 mg for the average adult. A single dose not exceeding 100 mg has been used in critical situations. One dose is usually sufficient; however, a second dose may be given at an alternate IV site if indicated.
Safety and effectiveness for use in pediatric patients not established; see Contraindications and Maternal/Child.
1 mg/kg of body weight; do not exceed adult dose.
Dose selection should be cautious in the elderly. Reduced doses may be indicated based on the potential for age-related impaired organ function and concomitant disease or drug therapy.
Reconstitute each 50 mg with 50 mL NS. D5W may be used if pH is above 5. D5W solutions with a pH at or below 5 may result in a hazy or opalescent solution; do not use. Do not add to IV solutions. May be given through the Y-tube of a running infusion or by direct IV injection.
Store vials at CRT. Discard reconstituted solution in 24 hours.
Manufacturer lists whole blood or its derivatives, solutions or drugs with a final pH below 5, and Normosol M.
Other sources suggest a few specific compatibilities dependent on concentration and manufacturer; consult a pharmacist.
Each 10 mg or fraction thereof (approximately 10 mL) may be given over several minute.
Infuse total dose slowly, evenly distributed over 20 to 30 minutes.
A potent diuretic agent; the sodium salt of ethacrynic acid. Acts on the ascending limb of the loop of Henle and on the proximal and distal tubules. Water and electrolyte excretion may be increased several times over that of most other diuretic agents and can be effective in patients with significant renal insufficiency. Will produce diuresis in acidosis or alkalosis. Effective within 5 to 10 minutes; reaches peak effect in 15 to 30 minutes and may last for 2 hours. Protein binding is high. Rapidly distributed. Metabolized in the liver and primarily excreted in the urine. Does not cross the blood-brain barrier.
Treatment of edema when greater diuretic potential is required or rapid onset of diuresis is desired.
■ Edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including nephrotic syndrome.
■ Acute pulmonary edema.
■ Short-term management of ascites due to malignancy, idiopathic edema, and lymphedema.
■ Short-term management of hospitalized pediatric patients, other than infants, with congenital heart disease or nephrotic syndrome.
Used alone or with NS to increase renal excretion of calcium in hypercalcemia.
■ Used concomitantly with mannitol in the management of ethylene glycol poisoning and to increase bromide excretion in the management of bromide intoxication.
Anuria.
■ Hypersensitivity to ethacrynic acid or any of its components.
■ Infants.
■ Severe, progressive renal disease with increasing azotemia and oliguria.
■ Severe watery diarrhea.
IV use indicated in patients unable to take oral medication or in emergency situations. For IV use only; do not use IM or SC.
■ Should be administered in a facility with adequate personnel, equipment, and supplies to monitor the patient and respond to any medical emergency. Effects are dose dependent and may result in profound electrolyte and water loss.
■ Use with caution in patients with cirrhosis of the liver, especially if they have a history of episodes of electrolyte imbalance or hepatic encephalopathy; may precipitate hepatic coma.
■ Too vigorous diuresis may induce an acute hypotensive episode.
■ Use caution in elderly cardiac patients; rapid contraction of plasma volume and hemoconcentration may result in thromboembolic episodes (e.g., CVA, pulmonary emboli), which may be fatal.
■ Use caution in patients receiving potassium-depleting steroids.
■ Use caution in patients receiving digoxin; potassium depletion may precipitate digoxin toxicity.
■ Risk of ototoxicity increased with higher doses, rapid injection, decreased renal function, or concurrent use with other ototoxic drugs; see Drug/Lab Interactions.
■ May increase glucose levels, uric acid levels, and urine output of magnesium.
Determine absolute patency of vein. Avoid extravasation. If a second dose is indicated, administer at an alternate site to avoid thrombophlebitis.
■ May precipitate excessive diuresis with water and electrolyte depletion. Obtain baseline electrolyte panel, CO2, BUN, and SCr and monitor closely.
■ Monitor for S/S of fluid or electrolyte imbalance (e.g., confusion, drowsiness, dryness of mouth, hypochloremic alkalosis, hypokalemia, hyponatremia, hypotension, lethargy, muscle fatigue, muscle pain or cramps, nausea and vomiting, oliguria, restlessness, seizures, tachycardia, thirst, weakness) and replace electrolytes as necessary. Monitor serum and urine electrolytes more closely in patients who are vomiting or are receiving parenteral fluids.
■ Monitor VS closely.
■ Liberalization of salt intake and supplementation with potassium chloride may be indicated.
■ If metabolic alkalosis is anticipated, the use of potassium chloride or a potassium-sparing agent (e.g., spironolactone [Aldactone]) before and during treatment with ethacrynic acid may attenuate or prevent hypokalemia.
■ Additional monitoring is required if treatment is continued with oral ethacrynic acid after the initial IV dose of ethacrynic acid.
■ See Precautions and Drug/Lab Interactions.
Hypotension may cause dizziness; request assistance with ambulation.
■ Promptly report dizziness, diarrhea, muscle weakness or cramps, nausea or vomiting.
■ May cause a decrease in potassium levels and require a supplement.
Category B: use during pregnancy with extreme caution and only if clearly needed; benefits must outweigh risks.
■ Discontinue breast-feeding.
■ Use in infants is contraindicated; use in pediatric patients is limited and is not recommended. Most experience is with oral dosing. See Pediatric Dose.
Dosing should be cautious; see Dose Adjustments
■ Response similar to that seen in younger adults.
■ Consider increased sensitivity to hypotensive and electrolyte effects and increased risk of circulatory collapse or thromboembolic episodes.
■ Monitoring of renal function is suggested.
Do not give simultaneously with whole blood or its derivatives.
■ May cause transient or permanent deafness when doses exceed the usual or when given in conjunction with other ototoxic drugs (e.g., aminoglycosides [e.g., gentamicin], cisplatin [Platinol], furosemide [Lasix]). Concurrent use with other ototoxic drugs is not recommended.
■ Has antihypertensive actions. May have an additive effect when used concurrently with other antihypertensive agents (e.g., hydralazine, nitroglycerin, nitroprusside sodium); reduced doses of both agents may be indicated.
■ Electrolyte depletion (especially hypokalemia) may increase with concurrent administration of other drugs that cause potassium loss, such as amphotericin B or corticosteroids (e.g., dexamethasone, hydrocortisone sodium succinate).
■ May increase or prolong the effects of nondepolarizing muscle relaxants (e.g., atracurium, pancuronium).
■ May interfere with the hypoglycemic effects of insulin and antidiabetic agents in patients with diabetes. Monitor glucose and serum potassium. Correct potassium levels first, then adjust insulin or antidiabetic agent dose as indicated.
■ Hypokalemia and hypomagnesemia may cause digoxin-induced arrhythmias; monitor potassium levels.
■ Synergistic effects with other diuretics may cause profound diuresis and serious electrolyte abnormalities.
■ May potentiate the effects of warfarin (Coumadin). Monitor INR; reduced warfarin dose may be indicated.
■ Concurrent use with lithium not recommended; renal excretion of lithium is decreased and potential for lithium toxicity is increased.
■ NSAIDs (e.g., ibuprofen [Advil, Motrin], naproxen [Aleve, Naprosyn]) may decrease the effects of diuretics; monitor carefully.
■ Probenecid may reduce urinary excretion and the effectiveness of ethacrynic acid.
■ Concurrent use with corticosteroids may increase the risk of gastric hemorrhage.
Most frequent with larger doses, in seriously ill patients, or with prolonged oral therapy. Abdominal discomfort or pain, agranulocytosis, anorexia, apprehension, chills, confusion, deafness (usually transient), diarrhea, dysphagia, fatigue, fever, GI bleeding, headache, hematuria, hyperglycemia, hyperuricemia, hypochloremic alkalosis, hypoglycemia, hypokalemia, hypomagnesemia, injection site pain and thrombophlebitis, jaundice and abnormal liver function, malaise, muscle cramps, nausea and vomiting, neutropenia, pancreatitis, skin rash, sudden onset of acute watery diarrhea, thirst, weakness.
Most common S/S are those caused by electrolyte depletion (e.g., hypochloremic alkalosis, hypokalemia, hyponatremia) and dehydration resulting from excessive diuresis. Cardiac arrhythmias may occur if digoxin is used concurrently. Circulatory collapse, deafness (permanent), embolism, hepatic coma, vascular thrombosis, and death have occurred.
Notify physician of all side effects. Minor side effects may be treated symptomatically. Reduce ethacrynic acid dose or discontinue if side effects are moderate or severe. Treatment of moderate to severe side effects is symptomatic and aggressive. If acute watery diarrhea or S/S of hepatic coma occur, discontinue therapy. Treatment of overdose is symptomatic and supportive. Correct dehydration, electrolyte imbalance, hepatic coma, and hypotension. Maintain an adequate airway and use oxygen or artificial ventilation for respiratory distress as indicated. Resuscitate as necessary.