In my ICU, the intensivists agree about almost everythig, except aggressive diuresis. I am happy diuresing people, as long as I know that they are euvolemic. Diuresing a hypovolemic patient will not do any good, because you will end up giving the fluid back (and more) once their pressure drops.

This is why a simple , minimally invasive blood volume monitor is the Holy Grail in many ways. Swan Ganz Catheters will usually give you a valid impression of fluid status, but it is invasive, and crazy in the recoveing patient who’s fluid status is unknown. A test of Lasix is reasonable, but what do you do if you give 20 of Lasix to a diuretic naive patient and get a poor response? Do you double the dose, or do you conclude the patient’s fluid status may be poor and their kidneys are saying “dummy, enough with the Lasix”.

So, if you see someone with low urine output and hypotension, fluid is the treatment, but I just want to make sure you look at the I’s and O’s, you look at the weight, you look at the BUN/Creatinine.  A lot of times they get a contraction alkalosis that causes confusion. I’ve seen patients pH get in the 7.5 range solely through diuresis, and though you will never see a good randomized study of this, it cant be good for the patient.