Effect of chronic furosemide administration on acid-base balance in patients with chronic hypercapnic respiratory failure

We quantitatively analyzed the effect of long-term administration of oral furosemide on the PaCO2 - H+ relationship in patients with chronic hypercapnic respiratory failure. In this study we measured arterial blood gases of eighteen outpatients (mean duration of visits, 7.6 years; mean rise of PaCO2, 15.4 mmHg). We obtained linear regression lines for PaCO2 - H+, and determined their Y-axis intercepts and slopes. The results indicated that an increase in the administered dose of furosemide decreased linearly the Y-axis intercept of the regression line [(Y-intercept) = - 6.9(dose of furosemide) + 30.9, r = 0.81], and increased linearly the slope of the regression line [(slope) = 0.094(dose of furosemide) + 0.22, r = 0.74]. Thus, the regression line of the PaCO2 - H+ relationship moved downward and became steeper at higher doses of furosemide. The regression lines for each dose of furosemide crossed at a PaCO2 of 75 mmHg. We concluded that there is a mutual interaction between the renal and respiratory mechanisms for acid-base balance in chronic hypercapnia and the effect of furosemide on the PaCO2 - H+ relationship is negligible in severe hypercapnia.