A 58-year-old woman presents to the ED with a 4 days of increasing shortness of breath, orthopnea, and dyspnea on exertion. She denies chest pain and claims compliance with her hypertension medication, enalapril. She had Stevens Johnson after taking Septra. Vital signs are BP 160/94, HR 90, RR 24, T 98.8, room air saturation 96%. Physical examination finings include bibasilar rales, JVD, and marked peripheral edema. An IV is established. She received sublingual nitroglycerin. What is the next appropriate step in treatment?
Bumetanide 1 mg IV
+Ethacrynic acid 50 mg IV
+Furosemide 40 mg IV
+Furosemide 40 mg PO
+Torsemide 10 mg IV
Ethacrynic acid, a loop-diuretic, is indicated for treatment of CHF, in patients with a significant sulfonamide allergy. Furosemide, bumetanide, and torsemide are all sulfonamide-containing loop-diuretics. Parenteral dosing of furosemide is preferable in fluid-overloaded patients, since bowel wall edema may diminish gastrointestinal absorption of an oral dose.