Which factor most strongly increases the risk of permanent sensorineural hearing loss from intravenous furosemide?
- A Rapid bolus injection in a patient with pre-existing renal impairment receiving concurrent aminoglycoside ✓
- B Slow infusion in a patient with normal renal function
- C Concurrent oral potassium supplementation
- D Use of the lowest effective dose in a well-hydrated patient
Correct answer: A. Rapid bolus injection in a patient with pre-existing renal impairment receiving concurrent aminoglycoside
Explanation
Loop diuretics impair the electrolyte environment of the endolymph in the inner ear by inhibiting the strial NKCC2 transporter. Ototoxicity is dose related and is dramatically amplified by rapid intravenous administration, high plasma levels from renal failure, and concurrent ototoxic drugs such as aminoglycosides or vancomycin. Slow infusion, low dosing and normal renal function all reduce risk. Potassium supplementation has no bearing on cochlear toxicity.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
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