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In many edematous states, in-creased Post Date: Tue, 14 Oct 2008 4:37:14 +0000 The exact mechanisms by which the kidney retains excessive amounts of sodium have been intensivelyexamined. Multiple factors are involved, each of which may vary in importance depending on the underlying etiology. In many edematous states, in-creased rates of aldosterone secretion have been correlated with increased tubular reabsorption of sodium. Autor of the post: Undefined However, quanti-tative studies, both Post Date: Tue, 14 Oct 2008 4:24:04 +0000 In addition, particularly in cardiac decom-pensation, the glomerular filtration rate may be re-duced, thus providing a diminished filtered load on which the tubular reabsorptive mechanism operates. This frequently can be correlated with a decreased concentration of urinary sodium. However, quanti-tative studies, both in disease and under experi-mental conditions, have failed to provide a pre-dictable relationship between the rate of sodium excretion and either the amount of sodium filtered or the activity of aldosterone. Autor of the post: Undefined Relationship of Drug Action to Pathologi-cal Post Date: Tue, 14 Oct 2008 4:11:52 +0000 For this reason, a "third factor" has been postulated that might regulate sodium reabsorption and excretion. However, at the moment, the nature of this factor is obscure and, indeed, several factors may be involved.Relationship of Drug Action to Pathologi-cal Physiology. Autor of the post: Undefined This is, of course Post Date: Tue, 14 Oct 2008 3:55:47 +0000 When the tubule reabsorbs excessive amounts of electrolyte and edema fluid accumulates, three therapeutic ap-proaches are available to mobilize the fluid and thereafter maintain the constancy of the extracellular fluid volume. The first is to cor-rect the primary disease, if possible. This is, of course, the most desirable goal, but it cannot always be achieved. Autor of the post: Undefined This is achieved pri-marily Post Date: Tue, 14 Oct 2008 3:37:42 +0000 The second is to suppress renal tubular reabsorptive capacity by the use of drugs. The third is to reduce the amount of sodium salts absorbed from the gastrointestinal tract to a degree com-mensurate with the diminished renal capac-ity for their excretion. This is achieved pri-marily by a low-salt diet. Autor of the post: Undefined Diuretic Drugs in the Treatment Post Date: Tue, 14 Oct 2008 3:18:58 +0000 In edema of cardiac origin, the first approach is almost invariably employed. Often all three approaches have to be combined.Diuretic Drugs in the Treatment of Cardiac Edema. Autor of the post: Undefined Yet it is clear Post Date: Tue, 14 Oct 2008 3:05:31 +0000 Our increased understanding of the patho-logical physiology of cardiac decompensation and of the nature of edema formation makes it clear that the total syndrome cannot be evaluated adequately in terms of a few simple causal relationships, but that multiple interactions are involved, many of a compensatory nature, some representing over-compensations. Granted the primary role of the cardiac dysfunction in the etiology of cardiac de-compensation, nevertheless, the additional contrib-utory roles of secondary physiological abnormalities cannot be denied. Yet it is clear that when the extensive electrolyte reabsorption is blocked, either by aldosterone antagonists от other drugs acting directly on the renal tubule, a chain of events is initiated that not only alleviates the symptoms of cardiac failure but also, by objective measurements, leads to an apparent improvement in myocardialperformance. Autor of the post: Undefined In general, these dis-tinctions refer Post Date: Tue, 14 Oct 2008 2:48:33 +0000 Accordingly, it is reasonable to ap-proach the therapy of cardiac decompensation in the belief that the appropriate correction of edema with diuretic agents may be beneficial to the total cardiac status.Certain practical distinctions may be made be-tween the therapeutic regimens directed toward the mobilization of edema fluid and toward the mainte-nance of the edema-free state. In general, these dis-tinctions refer to the choice of the type of diuretic, the route of administration, and the dosage. Autor of the post: Undefined The development of potent new Post Date: Tue, 14 Oct 2008 2:29:13 +0000 In all patients with cardiac decompensation, digitalis should be administered in full, adequate dosage and should be considered the primary therapeutic agent. Diuretic drugs acting directly on the kidney, irrespec-tive of their potency or effectiveness, must be con-sidered to have a secondary, albeit important, role. The development of potent new diuretics may have focused excessive attention on diuresis per se, and has led to the inadequate digitalization of some patients. Autor of the post: Undefined The diuretics are extensively employed Post Date: Tue, 14 Oct 2008 2:11:11 +0000 With the large number of diuretics now available, the choice of the agent depends primarily on the speed and magnitude of its action.Ascites. The diuretics are extensively employed in the management of ascites, especially when asso-ciated with cirrhosis of the liver. 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