PACE Case: Edema

An 88-year-old participant with congestive heart failure (CHF) had worsening pitting edema in her lower extremities that was not improving with various furosemide and metolazone doses. She was likely reaching end-of-life and PACE was looking for other options for managing this symptom.

CK INTERVENTION:
The CK clinical pharmacist consulted with PACE and recommended that they consider a trial with a different loop diuretic called torsemide. The rationale was two-fold: 1) torsemide is considered to be a longer-acting agent than furosemide (even though both are loop diuretics in the same class) and would present as a new chemical that she has not taken before — her body may in fact respond better to this agent; and 2) the only other practical option in this case would have been an IM or IV injection of furosemide to try to increase the bioavailability. Pursuant to their discussion, the physician decided to try the torsemide, so the CK clinical pharmacist provided the appropriate dosing strategy based on the participant’s previous furosemide dosing.

RESULT:
A week or so later, the nurse communicated that the torsemide did in fact reduce the participant’s swelling, and that the recommendation seemed to be relieving her symptoms more than previous attempts. The CK clinical pharmacist was grateful that he was able to assist in making her last month a bit more manageable by helping to reduce the swelling she was experiencing.

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