What is your approach to treating patients with decompensated heart failure when their hypervolemia is refractory to oral furosemide?  

Depending on the oral dose, it may just be a problem of underdosing or even perhaps non adherence. We would typically transition to intermittent IV lasix dosing with close monitoring. If minimal response can double the dose to try and get to the ceiling effect of lasix depending on the renal functio...