Heart failure: patients had a bigger diuresis with diuretics if they lay flat

Clinical bottom line (level 2b)

  1. Patients with congestive heart failure or liver cirrhosis and ascites who received diuretics and then lay supine for 6 hours compared with walking about, had a larger diuresis (on average 500 ml more) and a larger natriuresis (on average 50 mmol more).
Ring-Larsen et al: British Medical Journal 1986; 292: 1351-1353
Expires October 2003

The study

Unblinded ?concealed randomised cross-over trial ?with intention-to-treat
Setting: acute hospital, Denmark

12 patients (aged range 30 to 82 years; mean 60, ?% male) with cirrhosis and ascites or congestive cardiac failure (NYHA class II or III)
Note:
  • Each patient acted as his own control.


    • Control Group: (n = 6, 6 analysed): bumetanide 1 mg iv followed by normal daily activity
    Experimental Group: (n = 6, 6 analysed): bumetanide 1 mg iv followed by continuous bedrest

    100% followed for 6 hours

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    cumulated diuresis (ml over 6 hours) 626
    (223)     		1133
    (311)     		510
    (160 to 850)
    urinary sodium excretion (mmol/ 6 hours) 45
    (24)     		96
    (42)     		51
    (7.0 to 95)

    Citation

    1. Ring-Larsen H, Henriksen JH, Wilken C, et al: diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture. British Medical Journal 1986; 292: 1351-1353
    Contributor: Chris Ball and Clare Wotton, October 1999
    Reviewer:

    Clinical Question.
    Patient heart failure on dieretics
    Intervention or Exposure lying supine, flat
    Outcome diuresis