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The use of enteric-coated potassium Post Date: Mon, 13 Oct 2008 20:50:40 +0000 However, there is no simple correlation between the degree of hypokalemia and the total deficit.Dietary supplements of potassium may be prescribed, but they are contraindicated with triamterene or aldosterone antagonists. The use of enteric-coated potassium chloride-diuretic drug preparations should be avoided for reasons stated above. Autor of the post: Undefined Inadequate treatment of potassium deficits Post Date: Mon, 13 Oct 2008 20:40:05 +0000 The extent to which supplements prevent or correct potassium depletion in patients on long-term diuretic therapy varies from one patient to another (McKenna et al, 1971; Down et al, 1972; Edmonds and Jasani, 1972). An important variable is the dietary intake of potassium, which is often reduced in chronically ill pa-tients. Inadequate treatment of potassium deficits leads to a sustained catabolic state with progressive nitrogen loss. Autor of the post: Undefined The magnitude and the frequency Post Date: Mon, 13 Oct 2008 20:21:51 +0000 These derangements are readily prevented or reversed by appropriate supplemental potassium therapy (Walker et al, 1973).The rationale for the administration of spironolactone and triamterene has been discussed in connection with these agents. The magnitude and the frequency of potassium depletion are undoubtedly greater with the newer oral agents, other than the aldosterone antagonists and triamterene, in comparison to the mercurials. Autor of the post: Undefined The newer agents are often Post Date: Mon, 13 Oct 2008 20:08:28 +0000 This is usually attributed to an effect of the individual drugs. However, the dosage regimen may be an extremely important factor. The newer agents are often used continually; the mercurials were given intermittently, and, when the kidney was not under their influence, potassium was conserved. Autor of the post: Undefined Since magnesium and potassium deficits Post Date: Mon, 13 Oct 2008 19:49:01 +0000 An intermittent dosage schedule for the oral agents would undoubtedly reduce the severity of potassium depletion.Both extracellular and intracellular mag-nesium depletion may result from the use of diuretics. Since magnesium and potassium deficits may interact, the problem is complex and warrants more extensive evaluation (see Lim and Jacob, 1972). Autor of the post: Undefined This has enabled many patients Post Date: Mon, 13 Oct 2008 19:29:18 +0000 Refractory Edema. The increasing attention being given to so-called refractory edema is, in fact, partlyattributable to the high degree of success in the management of the less severely ill patient. This has enabled many patients with cardiac decompensation to survive longer in an edema-free state. Autor of the post: Undefined In addition to the factors implicit Post Date: Mon, 13 Oct 2008 19:15:03 +0000 With the progression of the underlying disease, these patients consequently tend to become edematous at a time when their cardiac reserve is significantly more im-paired than in the earlier years of their illness. Nev-ertheless, the patient with persistent and incapac-itating edema represents a major therapeutic challenge.In addition to the factors implicit in the nature of the underlying disease, the pharmacological properties of diuretic drugs must themselves be con-sidered to be important and common causes of diuretic refractoriness. Autor of the post: Undefined An additional factor in drug Post Date: Mon, 13 Oct 2008 18:55:13 +0000 With many drugs, diuretic efficacy is decreased by hyponatremia. With others, specific abnormalities of electrolyte metabolism lead to the refractory state. An additional factor in drug refractoriness is the reduction in glomerular filtration rate. Autor of the post: Undefined As edema subsides, the response Post Date: Mon, 13 Oct 2008 18:41:35 +0000 This may be related to the underlying disease state and may also be the result of prior diuretic therapy. It should also be emphasized that diuresis is limited in an overall sense by the extracellular fluid volume. As edema subsides, the response to an individual dose of most drugs diminishes until, as the edema-free state is approached, the magnitude of diuresis is necessarily smaller than at the height of the edema. Autor of the post: Undefined Bed rest itself may restore Post Date: Mon, 13 Oct 2008 18:27:52 +0000 When a patient becomes refractory to a diuretic, the entire regimen should be reevaluated. In some instances, minor adjustments of dosage may suffice. Bed rest itself may restore drug responsiveness, due to improvement in the renal circulation. 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