pem pearl: furosemide to expedite bladder filling in suspected ovarian torsion
We've all had the patient waiting and waiting for a full bladder to complete the pelvic US. We give bolus after bolus until they finally feel the urge to urinate so that the US tech will come do the study, all the meanwhile knowing that with every passing hour, the likelihood of ovary survival is decreasing.
This is a small pilot study that showed small doses of fusosemide significantly decrease time to bladder fullness in patients with concern for ovarian torsion. Both the study and control/placebo groups started with small, low volume bladders (each about 70ml) and received a 20ml/kg NS bolus. The study group received Lasix (0.1mg/kg up to 5mg) while the control/placebo group received a 5ml NS flush.
The study group reached a full, large bladder (based on POCUS) about 90 minutes faster than the control/placebo group. This also led to about a 90 minute improvement in both completion of the radiology-performed US and official read of the study. For some reason, there was only about a 45 minute difference in time to disposition that isn't discussed in the article.
Notably, there were a few outliers in the control/placebo group (4-5 hours before full bladder) that may make these numbers look a bit more substantial than they otherwise would (and in reality, if you're concerned about torsion, please don't wait 4-5 hours).
Bottom line: In this small pilot study, in pediatric patients presenting with concern for ovarian torsion, IV Lasix at 0.1mg/kg (max of 5mg) significantly decreased time to full bladder, time to completion of radiology-performed ultrasound, and time to official radiology read. Consider using this method next time you find yourself ordering fluids for the patient awaiting a full bladder for pelvic US
This is a small pilot study that showed small doses of fusosemide significantly decrease time to bladder fullness in patients with concern for ovarian torsion. Both the study and control/placebo groups started with small, low volume bladders (each about 70ml) and received a 20ml/kg NS bolus. The study group received Lasix (0.1mg/kg up to 5mg) while the control/placebo group received a 5ml NS flush.
The study group reached a full, large bladder (based on POCUS) about 90 minutes faster than the control/placebo group. This also led to about a 90 minute improvement in both completion of the radiology-performed US and official read of the study. For some reason, there was only about a 45 minute difference in time to disposition that isn't discussed in the article.
Notably, there were a few outliers in the control/placebo group (4-5 hours before full bladder) that may make these numbers look a bit more substantial than they otherwise would (and in reality, if you're concerned about torsion, please don't wait 4-5 hours).
Bottom line: In this small pilot study, in pediatric patients presenting with concern for ovarian torsion, IV Lasix at 0.1mg/kg (max of 5mg) significantly decreased time to full bladder, time to completion of radiology-performed ultrasound, and time to official radiology read. Consider using this method next time you find yourself ordering fluids for the patient awaiting a full bladder for pelvic US
