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Amisometradine and chlorazinil are not Post Date: Tue, 14 Oct 2008 6:54:09 +0000 Preparations and Dosage. Preparations of the xanthines are discussed elsewhere. Amisometradine and chlorazinil are not currently available for gen-eral use. Autor of the post: Undefined In general, they do not Post Date: Tue, 14 Oct 2008 6:41:44 +0000 Clinical Application. In clinical practice, these agents have received relatively limited application. In general, they do not have the efficacy of other diuretics. Autor of the post: Undefined THE CLINICAL USE OF DIURETICSThe Pathological Post Date: Tue, 14 Oct 2008 6:30:46 +0000 Continued use often leads to the loss of their effectiveness for reasons that have not been adequately explained. In addition, gastric irritation becomes a limiting factor with some agents.THE CLINICAL USE OF DIURETICSThe Pathological Physiology of Edema Forma-tion. Autor of the post: Undefined Several factors play an im-portant Post Date: Tue, 14 Oct 2008 6:20:30 +0000 The normal volume and composition of the extracellular fluid are regulated by multiple inter-acting mechanisms. In a healthy adult subject, changes in dietary intake or variations in the extra-renal loss of fluid and electrolytes are accompanied by relatively rapid and sensitive adjustments in the rate of renal excretion. Several factors play an im-portant role in determining the distribution of ex-tracellular fluid within the body and, as a conse-quence, in defining the nature of the stimuli that directly or indirectly influence the excretory func-tions of the kidney. Autor of the post: Undefined Theoretically, edema could occur Post Date: Tue, 14 Oct 2008 6:06:15 +0000 Edema is an increase in extracellular fluid volume. Accordingly, it represents a quantitative change in a normal component of the body. Theoretically, edema could occur in two ways, either from an abnormally high intake of water and electrolyte, or from an abnormally low rate of sodium excretion. Autor of the post: Undefined In the edematous states usually encountered Post Date: Tue, 14 Oct 2008 5:49:19 +0000 Under exceptional experimental circumstances, or as the result of excessively vigorous parenteral fluid therapy, it is possible for edema to result from too great a fluid or electrolyte intake. However, with normal renal function, such a condition is short lived.In the edematous states usually encountered in clinical medicine, in virtually every instance the underlying abnormality involves a decreased rate of renal excretion. Autor of the post: Undefined Possibly other factors may also Post Date: Tue, 14 Oct 2008 5:30:55 +0000 This applies regardless of the under-lying pathogenesis of the disease, whether cardiac, hepatic, or renal, or of some other etiology.The normal relationship between the volumes of interstitial fluid and the circulating plasma depends on dynamic equilibria across the capillary membrane and involves the pressure within the small blood vessels, the osmotic activity of the plasma proteins, the pressure within the tissue spaces, and the flow of lymph (see Chapter 36). Possibly other factors may also be involved, such as the effect of disease or the action of steroids, that may conceivably alter the state of the capillaries themselves. Autor of the post: Undefined In the nephrotic syndrome Post Date: Tue, 14 Oct 2008 5:18:02 +0000 In diseases of hepatic origin, particularly cirrhosis, the pressure relationships are disturbed primarily within the portal circulation, and the formation of edema becomes manifest as ascites. In congestive heart failure, pressure-flow relationships may be disturbed relatively more in either the systemic or the pulmonary circulation, and edema may be localized accordingly. In the nephrotic syndrome or other hypoproteinemic states, the equilibrium across all capillary membranes tends to be altered and edema fluid accumulates in a variety of tissues. Autor of the post: Undefined Sodium, chloride, and bicarbonate Post Date: Tue, 14 Oct 2008 4:59:39 +0000 However, in each instance the formation of significantly in-creased amounts of extracellular fluid is either pre-ceded or accompanied by decreased rates of renal excretion.There is overwhelming evidence to indicate that the primary disturbance in renal function involves the capacity of the kidney to excrete electrolyte. Sodium, chloride, and bicarbonate are quantitatively the most important ions of the extracellular fluid, and, of these, it is primarily the regulation of sodium excretion that is disturbed in the pathogenesis of edema. Autor of the post: Undefined Most frequently this is measured Post Date: Tue, 14 Oct 2008 4:47:41 +0000 Retention of extracellular electrolyte is accompanied by the retention of a proportional amount of water and, as a result, the increased vol-ume of extracellular fluid is usually of normal com-position and osmolality. However, particularly in severe instances of cardiac or hepatic decompensa-tion, water retention may be relatively greater than that of electrolyte, and hypoosmolality results. Most frequently this is measured in terms of the plasma sodium concentration, that is, as hyponatremia. 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