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With the availability of powerful Post Date: Mon, 13 Oct 2008 23:22:16 +0000 The theoretical hazards of high-ceiling diuretics have been previously outlined.Complications of Diuretic Therapy. With the availability of powerful diuretics, there has been an increased incidence of complications in the management of the edematous state that may be directly attributed to the diuresis itself. Autor of the post: Undefined The deleterious effects of fluid Post Date: Mon, 13 Oct 2008 23:06:14 +0000 It should be remembered that the goal of diuretic therapy is the mobilization of edema fluid in such a manner that the extracellular fluid is restored toward normal, in terms of both volume and composition. Electrolyte imbalance occurs when the volume change is excessive or too rapid, or when the diuresis itself results in an alteration in the electrolyte composition of either the extracellular or the intracellular fluid. The deleterious effects of fluid and electrolyte imbalance are seen particularly with the high-ceiling diuretics, not only because of the magnitude of the imbalance itself but also, perhaps more importantly, because of the rapidity of its development. Autor of the post: Undefined In intensive long-term therapy Post Date: Mon, 13 Oct 2008 22:51:21 +0000 The excessively rapid mobilization of edema may lead to malaise and asthenia. Rapid changes in the pressure-flow relationships in the cardiovascular system may, even in the presence of an expanded extracellular fluid volume, give rise to symptoms usually associated withhypovolemia. In intensive long-term therapy, the diuretic-induced renal loss of sodium chloride may lead to extracellular fluid de-pletion, with or without hyponatremia. Autor of the post: Undefined Both these conditions are relatively Post Date: Mon, 13 Oct 2008 22:36:41 +0000 By definition, in both acute and chronic ex-tracellular fluid depletion, there is a reduced amount of sodium in the extracellular space. The condition usually responds to discon-tinuation of the diuretic agent and the liber-alization of sodium chloride intake in the diet. Both these conditions are relatively rare, although undoubtedly more frequent with the introduction of the more efficacious agents. Autor of the post: Undefined It may occur solely Post Date: Mon, 13 Oct 2008 22:20:06 +0000 A far more common condition, particularly in congestive heart failure and hepatic cirrhosis, is chronic dilutional hyponatremia. This is associated with persistent edema and expanded extracellular volume. It may occur solely as a result of the underlying disease, but is most often seen as a consequence of diuretic therapy. Autor of the post: Undefined This is attributed Post Date: Mon, 13 Oct 2008 22:03:43 +0000 The physiological defect results from the inability of the patient to excrete an adequately dilute urine. The distal generation of positive free water is defective. This is attributed to an inadequate sodium load to this segment of the nephron. Autor of the post: Undefined The alkalosis resulting from mercurial Post Date: Mon, 13 Oct 2008 21:50:36 +0000 Water restriction is the most direct therapeutic approach, but may be complicated by uncontrollable thirst. Whether the diuretic regimen should be continued or altered is a perplexing problem for which there is no clear answer (see Jick, 1966; Walker, 1966).The alkalosis resulting from mercurial or high-ceiling diuretics is largely due to the relatively excessive loss of chloride. Autor of the post: Undefined However, supplements of potassium chloride Post Date: Mon, 13 Oct 2008 21:30:50 +0000 Although usually only moderate, the alkalosis may at times be extreme (DeRubertis et at, 1970). It may be corrected by ammonium chloride administration, thus excluding an obligatory role of potassium loss in its pathogenesis. However, supplements of potassium chloride also serve to lessen the alkalosis. Autor of the post: Undefined In addition, hyperkalemia may also Post Date: Mon, 13 Oct 2008 21:12:22 +0000 Many diuretics have a variable kaliuretic effect. The resultant hypokalemia increases the toxicity of digitalis. In addition, hyperkalemia may also result when excessively massive diuresis leads to acute hypovolemia and renal failure, or if potassium-sparing diuretics are used injudiciously. Autor of the post: Undefined True potassium depletion Post Date: Mon, 13 Oct 2008 21:01:56 +0000 With most diuretics, the magnitude of potassium excretion is often unpredictable. In addition to the type and the dosage of the diuretic itself, the other major determinant of kaliuresis is theactivity of the distal secretory mechanism for potassium, which is influenced by aldosterone (Espiner et al, 1967). True potassium depletion, with an intracellular deficit, may occur as a result of chronic diuretic therapy. 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