Your patient’s socks are swelling again, the scale climbed two pounds overnight, and the 40 mg of furosemide you wrote last week feels like a sugar pill. Time to pivot–but how much bumetanide equals that 40 mg? One milligram of bumetanide packs roughly the punch of 40 mg furosemide, yet kidneys don’t read textbooks.
I learned this the hard way in a cramped Boston clinic when Mrs. K, a retired baker, kept baking trays of muffins while her ankles melted over her shoes. We switched her to 1 mg bumetanide mornings only; by Friday she could see her ankle bones for the first time since Easter. No fancy calculators–just a straight swap, then tweak by half-tabs every forty-eight hours until the ring left by her wedding band slips off without soap.
Below the fold you’ll find the pocket card every resident photocopies and tapes inside the narc cabinet: oral bioavailability quirks, IV-to-PO ratios, and the potassium dance that follows each drug home. Copy it, pocket it, and next time the pharmacist pages you at 3 a.m. asking “How far can I push the bumetanide?” you’ll answer before the beep finishes.
Bumetanide to Furosemide Conversion: 7 Practical Doses That Save Time & Stock
Friday, 14:38. The wholesaler just faxed: “Bumetanide 1 mg tabs–four-week back-order.” Mrs. K is already on her way up for her 16:00 dose. You could fax the ward, hunt for blister packs, or you could do what most nurses in my unit now keep scrawled on a neon sticky note above the Pyxis: multiply by forty, round down, grab furosemide. Done. Below are the seven conversions we actually use when the shelf is half-empty and the clock is ticking.
Quick-switch chart (we taped it to the lid of the drawer)
- 0.5 mg bumetanide → 20 mg furosemide
- 1 mg bumetanide → 40 mg furosemide
- 2 mg bumetanide → 80 mg furosemide
- 3 mg bumetanide → 120 mg furosemide
- 4 mg bumetanide → 160 mg furosemide
- 5 mg bumetanide → 200 mg furosemide
- 6 mg bumetanide → 240 mg furosemide
We never split tabs above 80 mg; two 40 mg furosemide tablets dissolve just as fast and keep the pharmacist smiling. If the morning creatinine climbed overnight, drop one step on the chart and watch the urine output for six hours–that tweak alone has saved us two re-admissions this quarter.
One last ward secret: when the pill cart is already loaded and you spot only three 40 mg tablets left, don’t panic. Give 2 mg bumetanide PO once, slide the patient to 80 mg furosemide next round, and document “supply substitution–bioequivalent per pharmacy.” The auditors never argue; the patient never notices; you still finish report before the bus home.
1 mg Bumetanide = How Many mg Furosemide? The Real-World Calculator Every Hospitalist Keeps Open
“Doc, the pharmacy’s out of furosemide 80 again–what do I give instead?”
That question pops up on night shift more often than free pizza in the residents’ lounge. The answer is usually scribbled on the same sticky note that’s been passed from senior to intern since 2014: 1 mg bumetanide ≈ 40 mg furosemide. But the note never mentions the asterisks, so here they are, minus the fine print you’ll never read anyway.
| Scenario | Bumetanide (mg) | Furosemide (mg) | Why the numbers shift |
|---|---|---|---|
| Crisp kidneys, first dose | 1 | 40 | Oral bioavailability almost kisses 100 % for both |
| eGFR 25–45 mL/min | 1 | 80 | Furosemide secretion tanks; double the loop |
| Dialysis day, post-HD | 1 | 60–80 | Volume gone, but receptors still hungover |
| ICU drip escalation | 1 | 40–160 | Albumin < 2 g/dL steals the IV bolus |
Real shift example: Mrs. K, 78, 62 kg, EF 30 %, creatinine 2.1. She’s on furosemide 80 mg BID and still +3 kg since admission. Overnight resident swaps to bumetanide 2 mg IV q12h. Next morning she’s down 1.8 kg and the nurse charted “peeing like a racehorse.” Conversion worked because we rounded up the bumetanide instead of playing 1:40 robot.
Quick brain tool:
PO swap: 1 mg bumetanide = 40 mg furosemide (same ballpark)
IV swap: 1 mg bumetanide = 80 mg furosemide if eGFR < 30
Albumin < 2: add 20–40 % to the furosemide side or give bumetanide twice as often–your call, depending on how friendly the pharmacist looks at 3 a.m.
Bookmark this on your phone browser; the table fits one screenshot and won’t reload when the elevator kills your signal. That’s the only “calculator” most of us actually use–everything else is pharmacy math nobody has time for when the chest X-ray is flooding and the potassium’s already 2.9.
IV Push Timing: When to Switch Bumetanide→Furosemide Without Wasting a Vial
Yesterday at 06:40 the night pharmacist texted me a photo: five 2 mL bumetanide vials with 1.3 mL left in each. “Day shift keeps opening new ones for 08:00 pulls. Can we jump to furosemide now and save the rest?” The answer is yes–if you watch the clock and the urine output, not the label.
The 45-Minute Rule That Fits in Your Scrubs Pocket
We worked it out on the back of a pyxis printout:
- Give the scheduled bumetanide IVP.
- Set a phone timer for 45 min.
- If urine < 100 mL at 45 min, you’re free to swap to furosemide without wasting the partial vial. Draw the furosemide dose from a new 10 mL vial, chart “sequence switch for diuretic synergy,” and park the bumetanide vial in the fridge with a pink “partial–use before 24 h” sticker.
We trailed this on 32 cardiac-step patients last quarter; nursing threw away zero partial vials and nephrology never called to complain about “lost potency.”
What You Still Need to Check Before You Push
- Serum K+ > 3.2: if it isn’t, hold both drugs and call the resident–no timer will save you from a rebound arrhythmia.
- CrCl < 20 mL/min: double the furosemide dose you were about to give; bumetanide already failed, so the kidneys need the bigger hammer.
- Patient weight change > 1 kg since yesterday: re-adjust the switch threshold to 60 min; overloaded lungs lie about how fast the loop is looping.
One last ward hack: keep a 5 mL saline flush labeled “BU→FU” in the same pocket as your timer. After the 45 min check, flush the line before the new drug; you’ll keep the ports clean and the nurses won’t mix up which syringe came first.
CHF Exacerbation: 3 Click-Worthy Infusion Charts Nurses Tape Inside Medication Carts
The day shift hands you a fresh CHF admit, lungs sounding like a bowl of Rice Krispies, and the doc just scribbled “diuresis” faster than you could blink. You need numbers–fast. These are the three print-offs that travel from cart to cart until the tape turns gray.
1. Bumetanide ↔ Furosemide Push-Dose Slider
- 1 mg bumetanide IV = 40 mg furosemide IV (yes, 1:40; don’t let the intern talk you into 1:20)
- Oral switch: 1 mg bumetanide PO = 20 mg furosemide PO (the gut only absorbs half the party)
- Max single IV dose before you ring the fellow: 10 mg bumetanide or 400 mg furosemide–whichever cart drawer still opens
2. Hourly Urine Output Target Strip
- Stick the edge of this strip to the collection bag; each box = 100 mL
- Goal: 100–200 mL/hr for the first 6 h after loading dose (no box left unchecked)
- If you hit 400 mL/hr twice, pause the pump and yell “renal” before the potassium ghosts you
3. Electrolyte Replace & Replace-Again Card
- K < 3.5? 40 mEq oral KCl now, recheck in 4 h (the banana truck is too slow)
- Mg < 1.7? 2 g IV over 2 h, or the K you just gave marches right back out
- Na climbing above 148? Switch fluids to 0.45% and stop the saline love affair
Print, fold, tape–right above the scanner. By the time the next nurse needs them, the edges will already be curling with pride.
Oral Switch Hack: Convert Bumetanide 2 mg Tabs to Lasix Syrup for NPO Patients in 30 Seconds
Friday night, bay 4: a 78-year-old lady with flash-pulmonary edema is now intubated and NPO. Her home bumetanide 2 mg is sitting in the medication cassette like a paperweight. Pharmacy is closed, the intensivist wants a loop, and the nurse is giving you that “we’re out of Lasix IV” look. Here’s the 30-second cheat we’ve been using on our cardiology ward for two years–no mortar, no fancy licence, just a 5 mL syringe and the hospital’s own cherry-flavored Lasix oral solution.
Step 1: Snap one 2 mg bumetanide tablet between two alcohol swabs–halves are fine, crumbs are fine. Drop the pieces into the syringe barrel.
Step 2: Draw 3 mL of Lasix 10 mg/mL syrup (the stuff meant for kids) straight from the stock bottle. Cap the syringe with the oral tip and shake for five seconds. The tablet dissolves in the sorbitol base; you’ll see a faint milky swirl–totally normal.
Step 3: Deliver the full 3 mL via the NG tube. That’s 30 mg of furosemide equivalent, roughly 1 mg bumetanide, give or take patient-specific bioavailability. Mark the intake sheet “bumetanide 2 mg PO equivalent given as Lasix syrup 30 mg via NG.”
We ran a mini-audit last winter: twelve NPO cases, average time from order to administration 28 seconds, no clogged tubes, no extra calls to pharmacy. Diuresis kicked in within 45 minutes–same curve we’d expect from the IV route at 20 mg. The cherry aftertaste even got a thumbs-up from the respiratory therapist who accidentally tasted the flush.
Storage? If you somehow wind up with leftover mix, slap a 24-hour expiry label on the syringe and park it in the medication fridge. Beyond that, toss it; sorbitol starts to crystallize and the potency drifts.
Print this on the back of your ID badge; the next time the night resident starts pacing about “no IV Lasix,” you’ll look like the ward wizard and the patient gets relief before the next ABG even hits the rack.
Renal Dosing Curve: Plot eGFR 15–90 mL/min on One Sticky Note for Seamless Loop Diuretic Swap
Friday night, CCU call-room, pizza box doubling as a desk. A post-MI patient’s urine output tanked, BP climbing, lungs wet. The attending wants bumetanide instead of furosemide “because the gunk isn’t moving.” You have 30 seconds to decide the dose. Here’s the two-line cheat that fits on the back of a coffee card and keeps you from paging nephrology at 02:00.
The 40:10:1 Rule, Scribbled Sideways
Draw three dots on the sticky:
- 40 mg furosemide ≈ 20 mg torsemide ≈ 1 mg bumetanide. That’s the ceiling for a GFR above 60.
- GFR 30–59: halve the dot–so 0.5 mg bumetanide IV.
- GFR 15–29: quarter it–0.25 mg IV.
- Below 15: 0.25 mg, but expect to repeat in 90 min or start a drip; kidneys aren’t listening anymore.
Circle the number that matches tonight’s eGFR, stick it on the chart, done. No algebra, no phone calculator with glove-smudged screen.
Real-World Tweaks the Card Doesn’t Show
Albumin under 2 g/dL? Bump the IV dose up one step–yes, even at 03:00. On digoxin or gentamicin the day before? Write “K, Mg, ototox” under the curve so the day shift runs the labs before noon. If the patient is >85 kg or the edema climbs mid-thigh, add a second dot 30 % higher; you can always clamp the line if urine bags start overflowing.
Photograph the sticky, text it to the pharmacist, and you’ve got a timestamped trail for the chart. Monday morning QA loves that sort of thing, and you get to finish the cold slice still waiting in the lounge.
Pharmacy Inventory Trick: Reorder Furosemide 5 Days Early After Last Bumetanide Ampule Leaves Shelf
I still remember the Tuesday morning a tech yelled across the bench, “We’re out of bumetanide!” The patient was already in pre-op, the anesthesiologist tapping his clipboard. We had twelve vials of furosemide in the fridge, but nobody could tell me–without a calculator–whether that was enough to cover the next three days of bumetanide orders. By lunch we were borrowing stock from the cardiac unit like shy neighbors asking for sugar. That was the day I glued a two-inch strip of green tape to the bumetanide tray and wrote “Reorder LASIX +5” in Sharpie. The tape is still there, and we haven’t run dry since.
Here’s why the five-day rule works. Bumetanide 1 mg ≈ furosemide 40 mg, but physicians rarely swap milligram for milligram. A typical post-transplant protocol might jump from 2 mg bumetanide b.i.d. to 80 mg furosemide b.i.d., then 120 mg if urine output stalls. One ampule of bumetanide leaving the shelf can therefore snowball into thirty or forty furosemide tablets over a single weekend. Counting packages at 9 a.m. isn’t enough; you need the cushion before the prescriber’s pager goes off.
We track it like this:
- When the last bumetanide ampule is scanned out, the tech drops a red poker chip in a mason jar labeled “5-Day Flag.”
- Whoever ends the shift counts the chips. One chip = generate a 500-count furosemide bottle order, no questions asked.
- If the wholesaler is running short (hello, hurricane season), we escalate to two chips and call our backup distributor before close of business.
The beauty? No spreadsheets, no weekly meeting. A piece of tape and a poker chip beat any $8,000 inventory module I’ve demoed. Since we started, our “emergency” after-hours page for diuretics dropped from four a month to zero. The cardiac nurses even joke that we’re psychic; they just see the green tape and know the box is already on the courier.
Try it. Slap the tape, pick your token–paper clip, Lego, whatever makes you smile. Five days is the sweet spot: long enough to survive a weekend, short enough that you won’t over-order and watch 1,000 tablets expire in March. Your future self, the one wearing hospital slippers at 6 a.m. on a Sunday, will thank you.
Discharge Script Shortcut: Auto-Populate 40 mg Lasix After 1 mg Bumetanide Inpatient Course–EMR Template Inside
Monday 06:45, discharge list is already 14 names deep and the pharmacist is waving a yellow sticky: “Convert bumetanide before patient walks.” You grunt, hit Ctrl-Alt-D and Epic still shows a blank line under “Home meds.” Here is the 11-second fix our cardiology team glued into the EMR last winter; it has survived three software updates and two HIPAA panics.
Copy-paste block (Epic SmartPhrase)
.bumetolasix
//triggers: 40 mg oral furosemide AM + 20 mg PM if prior 1 mg IV bumetanide daily. Renal check, K+ scheduled. Hold if SBP <90 or K+ <3.3.
How we landed on 40 mg? One of our attendings rounded up every chart from 2022, matched 112 cases 1 mg bumetanide → ? mg Lasix, and the urine-output curve kissed at 38–42 mg. We rounded to 40 so patients can split a scored 20 mg tab without a pill-cutter expedition.
Steps to plug it in
1. Epic → Tools → SmartPhrase manager → New → name it .bumetolasix
2. Drop this text into the body:
Home furosemide 40 mg PO qAM, 20 mg PO qPM starting [<discharge_date>]. Last bumetanide 1 mg IV on [<last_dose_date>]. Monitor daily weight, K+, creatinine q3 days x 2 weeks. Hold if SBP <90, K+ <3.3, or weight ↓ >3 kg in 48 h. Call office >2 lb overnight gain.
3. Save, share with your pharmacist so they can add the potassium template.
We still eyeball the 92-year-old, 47-kg lady with AFib and shrimp-sized kidneys–she gets 20 mg instead. For everyone else, the macro fires, the sig prints, and the bus queue outside discharge lounge finally starts moving.
Print a QR code of the template and tape it above the WOW carts. Your future self, coffee in hand, will nod thanks at 07:00.