19th February 2025

An 82-year-old lady is brought into the emergency department with a history of shortness of breath and is requiring 5 L/min of oxygen to maintain her saturations in the range of 94-98%.

An 82-year-old lady is brought into the emergency department with a history of shortness of breath and is requiring 5 L/min of oxygen to maintain her saturations in the range of 94-98%. She has a background of hypertension, mild COPD, heart failure, previous MI and type 2 diabetes mellitus. Her current medications 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 10 mg OD. She reports that she ran out of her medication a week ago but was unable to get a repeat prescription.

History and examination are suggestive of her having a decompensation of her heart failure with pulmonary oedema. Her observations are: heart rate 101, blood pressure 145/78, respiratory rate 22 and saturations 95% on 5L/min.

You decide to start diuretic therapy. What would your initial diuretic regime be?

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