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Many types of diuretics having Post Date: Tue, 14 Oct 2008 1:56:06 +0000 Periodic adminis-tration either eliminates the necessity for or reduces the interval between paracenteses. Not only does a diuretic regimen contribute to the comfort of the patient, but also his meager protein reserves are spared inasmuch as significant amounts of protein are lost when ascitic fluid is mechanically with-drawn. Many types of diuretics having a direct renal action may be prescribed. Autor of the post: Undefined Sec-ondary hyperaldosteronism is an underlying Post Date: Tue, 14 Oct 2008 1:40:22 +0000 If effective, a single drug should be employed. However, since cirrhotic edema may be exceptionally refractory, the concomitant use of different types of agents is often indicated. Sec-ondary hyperaldosteronism is an underlying factor influencing the diuretic response. Autor of the post: Undefined In severely ill patients there Post Date: Tue, 14 Oct 2008 1:24:57 +0000 Electrolyte im-balance is a frequent complication of diuretic therapy in cirrhosis. Because of this, diuretics should be employed in the smallest possible doses. In severely ill patients there is a greater risk of too vigorous therapy, and it may be advisable purposefully to aim for less than the complete mobilization of edema (Sherlock, 1973). Autor of the post: Undefined With the introduction of new Post Date: Tue, 14 Oct 2008 1:11:33 +0000 With mild, asymptomatic, or resid-ual ascites, no useful purpose is served in attempting to make the patient completely free of edema if this involves the persistent administration of diuretics and the production of hypovolemia or electrolyte imbalances.Renal Disease. With the introduction of new and more potent diuretics, there has been a gradual change in their use in the management of diseases of the kidney. Autor of the post: Undefined In the case Post Date: Tue, 14 Oct 2008 0:51:53 +0000 As a general rule, chronic renal disease with edema may be treated in the same manner as other edematous states, with the recognition that these patients are more subject to electrolyte im-balance. In the presence of primary renal disease there is often a lesser effect of the diuretic on tubular function. In the case of the high-ceiling diuretics, particularly furosemide, an increased dose is re-quired. Autor of the post: Undefined The mercurials are effective Post Date: Tue, 14 Oct 2008 0:40:18 +0000 This can be accomplished without any direct deleterious effect on the underlying renal disease(Muth, 1973). The thiazides are relatively less effec-tive and in high doses may decrease the glomerular filtration rate. The mercurials are effective to a vari-able degree. Autor of the post: Undefined If diuretics are required, mercurials Post Date: Tue, 14 Oct 2008 0:25:17 +0000 However, if the desired diuresis is not obtained, one should discontinue them rather than increase the dose. In acute glomerular nephritis, hypervolemia and edema are often self-limited. If diuretics are required, mercurials should be avoided because of their ineffectiveness and their potential nephrotoxicity in this condition. Autor of the post: Undefined Mercurials are frequently ineffective Post Date: Tue, 14 Oct 2008 0:13:35 +0000 In the nephrotic syndrome, the response to diuretic agents is often disappointing. Although hypo-proteinemia is a major etiological factor, the ad-ministration of albumin produces a minimal and unpredictable diuretic response. Mercurials are frequently ineffective. Autor of the post: Undefined Their influence on the course Post Date: Mon, 13 Oct 2008 23:59:27 +0000 Thiazides, ethacrynic acid, furosemide, and aldosterone antagonists are the most successful. The important role of the corticosteroids in the management of the nephrotic syndrome is discussed elsewhere. Their influence on the course of nephrotic edema is related either to an increase in glomerular filtration rate or to an action on the underlying disease process, rather than to a direct effect on the renal handling of electrolyte. Autor of the post: Undefined The problem is dis-cussed Post Date: Mon, 13 Oct 2008 23:40:25 +0000 In incipient acute renal failure, diuretics have been used to maintain urine flow in the hope that this may diminish further renal damage. The success of this practice is difficult to evaluate. The problem is dis-cussed in the section on osmotic diuretics and in Chapter 36. 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