Spironolatone: Titrate up to 400 mg/d as needed.

Loop diuretic: Titrate single daily dose up to ceiling dose* as needed.

Loop diuretic: increase frequency of ceiling dose as needed: furosemide, up to 3X daily; Bumetanlde, up to 4X dally; Torsemide, up to 2X daily

K+-sparing diuretic:

If CrCI > 75 & urinary [Na]:[K] ratio is < 1 (Note: May add K+-sparing diuretic to loop and/or Thiazide diuretic at any point in algorithm for K+ homeostasis.)

Thiazide diuretic:

i mg/d HCTZ 1100 mg/d HCTZ CrCI < 20, use 100 to 200 mg/d HCTZ

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