INTRODUCTION: Diuretic responsiveness in @entity1 with @entity712 ( @entity712 ) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of @entity1372 and water excretion is reached prior to optimal fluid elimination and may be overcome when @entity4372 saline solution (HSS) is added to high doses of @entity1483 . METHODS: Forty-two consecutively hospitalized @entity1 with refractory @entity712 were randomized in a 1:1:1 ratio to @entity1483 doses (125  mg, 250  mg, 500  mg) so that all @entity1 received intravenous @entity1483 diluted in 150  ml of normal saline (0.9%) in the first step (0-24  h) and the same @entity1483 dose diluted in 150  ml of HSS (1.4%) in the next step (24-48  h) as to obtain 3 groups as follows: Fourteen @entity1 receiving 125  mg (group  1), fourteen @entity1 receiving 250  mg (group  2), and fourteen @entity1 receiving 500  mg (group  3) of @entity1483 . Urine samples of all @entity1 were collected at 30, 60, and 90  min, and 3, 4, 5, 6, 8, and 24  h after infusion. Diuresis, @entity1372 excretion, osmolality, and @entity1483 concentration were evaluated for each urine sample. RESULTS: After randomization, 40 @entity1 completed the study. Two @entity1 , one in group  2 and one in group  3 dropped out. @entity1 in group  1 (125  mg @entity1483 ) had a mean age of 77      17  years, 43% were male, 6 (43%) had @entity712 with a preserved ejection fraction (HFpEF), and 64% were in New York Heart Association (NYHA) class IV; the mean age of @entity1 in group  2 (250  mg @entity1483 ) was 80      8.1  years, 15% were male, 5 (38%) had HFpEF, and 84% were in NYHA class IV; and the mean age of @entity1 in group  3 (500  mg @entity1483 ) was 73      12  years, 54% were male, 6 (46%) had HFpEF, and 69% were in NYHA class IV. HSS added to @entity1483 increased total urine output, @entity1372 excretion, urinary osmolality, and @entity1483 urine delivery in all @entity1 and at all time points. The percentage increase was 18,14, and 14% for urine output; 29, 24, and 16% for total @entity1372 excretion; 45, 34, and 20% for urinary osmolarity; and 27, 36, and 32% for total @entity1483 excretion in groups 1, 2, and 3, respectively. These findings were translated in an improvement in the @entity1483 dose-response curves in these @entity1 . CONCLUSION: These results may serve as new pathophysiological basis for HSS use in the treatment of refractory @entity712 .

Hypertonic Saline in Conjunction with High-Dose XXXX Improves Dose-Response Curves in Worsening Refractory Congestive @entity712 .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity712 :: ('MESH:D006333', 'Disease') :: ['chronic heart failure', 'heart failure', 'CHF'] @entity1372 :: ('MESH:D012964', 'Chemical') :: ['sodium'] @entity1483 :: ('MESH:D005665', 'Chemical') :: ['furosemide'] @entity4372 :: ('MESH:D009122', 'Disease') :: ['hypertonic']
@entity1483 :: (MESH:D005665,Chemical) :: ['Furosemide']
