It's been a while since my last podcast. I think there's a few reasons for that, but partly because I started reading a long book about helium and I just couldn't put it down.

Today I'm going to continue with a theme of trying to get rid of articles in my cabinets.

And I'm going to avoid studies say I'm going to try and get rid of some

review articles I thought were really well done over the past couple years that have been

piling up for me and some great points that I took away from them. The first article I do want to

discuss is called diuretic treatment and heart failure.

So this came out of the New England Journal on November 16, 2017 by Dr. David Ellison and Dr.

Michael Felker. And I love how they start off with just honesty, which is basically that there are not a lot of large,

well-controlled clinical trials to guide the use of diuretics in heart failure. But then they go on

and give some terrific points of things we don't know or suspect that we do know. One of the first

pearls I got out of it was they were talking about

loop diuretics and intravenous ferrosamide or LASX. And when you have a patient come to the hospital

and let's say they're on 40 or 80 milligrams of LASX a day and you decide you're going to give them an IV dose of

Furozomide, how potent is that dose compared to their oral dose if you're going to give it

through the IV?

And what they say is it's approximately twice as potent on a per milligram basis as an oral dose.

So I guess if you're giving 40 milligrams of Lasix IV, it's going to be about twice as potent as if they

were just taking it orally at home. And of course much of the article talks about what you should do if someone comes into the

hospital with fluid retention, with significant edema, whether that be peripherally or pulmonary

edema or both often is the case. And there's a lot of reasons why you get diuretic resistance. One is they're just

not taking the dose. Now, we all know that. Patients dislike taking diuretics. If you give a

diuretic for a first time to a patient in a hospital, it works amazing. And then you tell the

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