Fact or Fallacy: Co-administration of Albumin with Furosemide to Overcome Diuretic Resistance in Critically Ill Patients
by Meagan Macalalag, PharmD, Jeffrey Fish, PharmD, BCCCP, FCCM
Question:
Should albumin be co-administered with furosemide to overcome diuretic resistance in critically ill patients?
One of the many complexities of critically ill patients is their dynamic fluid requirements, making fluid management a challenging aspect in the intensive care unit (ICU). While patients may present with volume overload, some may develop it as a result of fluid resuscitation, a common ICU intervention. Volume restriction and diuretics are the mainstay for fluid management in critically ill patients. Nearly 50% of ICU admissions will receive diuretics, most commonly loop diuretics, with furosemide accounting for more than 90%. Patients will have varying degrees of volume overload and diuretic response, two considerations that will dictate the ability to optimize fluid balance. Diuretic resistance may occur in critically ill patients and is often observed in patients with congestive heart failure, liver cirrhosis, and chronic kidney disease. It is generally defined as the failure to achieve therapeutically desired outcomes, such as urine output, given an inadequate response to diuretics. Despite this consensus, there is no universally accepted metric to quantify diuretic resistance.
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2026 March/April Table of Contents
Question:
Should albumin be co-administered with furosemide to overcome diuretic resistance in critically ill patients?
One of the many complexities of critically ill patients is their dynamic fluid requirements, making fluid management a challenging aspect in the intensive care unit (ICU). While patients may present with volume overload, some may develop it as a result of fluid resuscitation, a common ICU intervention. Volume restriction and diuretics are the mainstay for fluid management in critically ill patients. Nearly 50% of ICU admissions will receive diuretics, most commonly loop diuretics, with furosemide accounting for more than 90%. Patients will have varying degrees of volume overload and diuretic response, two considerations that will dictate the ability to optimize fluid balance. Diuretic resistance may occur in critically ill patients and is often observed in patients with congestive heart failure, liver cirrhosis, and chronic kidney disease. It is generally defined as the failure to achieve therapeutically desired outcomes, such as urine output, given an inadequate response to diuretics. Despite this consensus, there is no universally accepted metric to quantify diuretic resistance.
Download PDF
2026 March/April Table of Contents