Urine output and signs and symptoms of congestion should be serially assessed, and the diuretic dose should be adjusted accordingly to relieve symptoms, reduce volume excess, and avoid hypotension (312). (Level of Evidence: B) Table 22. Recommendations for Therapies in the Hospitalized HF Patient Recommendations COR LOE References HF patients hospitalized with fluid overload should be treated with intravenous diuretics I B 310,311 HF patients receiving loop diuretic therapy should receive an initial parenteral dose greater than or equal to their chronic oral daily dose; then dose should be serially adjusted I B 312 HFrEF patients requiring HF hospitalization on GDMT should continue GDMT except in cases of hemodynamic instability or where contraindicated I B 307 309 Initiation of beta-blocker therapy at a low dose is recommended after optimization of volume status and discontinuation of intravenous agents I B 307 309 Thrombosis/thromboembolism prophylaxis is recommended for patients hospitalized with HF I B 22,324 328 Serum electrolytes, urea nitrogen, and creatinine should be measured during titration of HF medications, including diuretics I C N/A When diuresis is inadequate, it is reasonable to IIa a. give higher doses of intravenous loop diuretics; or b. add a second diuretic (e.g.