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A 72-year-old woman with a history of diabetes, hypertension and dyslipidemia presents to the ED with dyspnea and weakness. Medications include amlodipine, metformin and atorvastatin. Physical exam is notable for a HR of 88, RR 24, BP 185/95, O2 saturation of 91% on room air. There are bilateral crackles, with an elevated JVP and peripheral edema to the lower extremities. Blood work shows a newly elevated creatinine of 275 µmol/L. Electrolytes and venous blood gas are normal. A portable chest x-ray demonstrates pulmonary edema. In addition to providing supplemental oxygen and nitroglycerine, you decide to treat with furosemide, as the patient has an acute kidney injury with associated pulmonary edema and adequate perfusion. What dose should you use?
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