19th February 2025

A 74-year-old lady is brought into the emergency department with a history of progressive shortness of breath and is requiring 3 L/min of oxygen to maintain her saturations in the range of 94-98%.

A 74-year-old lady is brought into the emergency department with a history of progressive shortness of breath and is requiring 3 L/min of oxygen to maintain her saturations in the range of 94-98%. She has a background of hypertension, heart failure, previous MI and type 2 diabetes mellitus. Her current medication are: amlodipine 5 mg OD, ramipril 5 mg OD, bisoprolol 5 mg OD, metformin 500 mg BD, furosemide 40 mg OD, aspirin 75 mg OD, empagliflozin 10mg OD.

She reports that she stopped taking certain of her medications two weeks ago as she ran out, but picked up a repeat prescription today, after which she took double the dose to compensate for missing two weeks. She has felt light headed since then.

History and examination are suggestive of her having a decompensation of her heart failure and pulmonary oedema. Her observations are: heart rate 86, blood pressure 91/51, respiratory rate 22 and saturations 97% on 5 L/min. You trial her with an intravenous bolus of 80 mg furosemide but her blood pressure drops to 75/39 and she becomes more light headed, although she does achieve good diuresis with this. What would be your next steps in diuretic therapy?

Select the SINGLE most appropriate option from the list below. Select ONE option only.