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Most patients receive mercurial diuretics Post Date: Wed, 15 Oct 2008 17:59:48 +0000 This has been termed subtraction alkalosis. It does not inevitably occur. Most patients receive mercurial diuretics at intervals of several days, and the drug is active only over a period of hours. Autor of the post: Undefined When this occurs, the individual Post Date: Wed, 15 Oct 2008 17:48:18 +0000 Therefore, compensation for the distortion in the composition of extracellular fluid produced by the mercurial can be achieved by the kidney after the action of the diuretic has sub-sided. However, when mercurial diuretics are given in intensive courses or when renal function is inad-equate to achieve rapid compensation, and when dietary intake of sodium chloride is excessively low, a persistent systemic alkalosis may develop. When this occurs, the individual may become refractory to the action of the mercurial diuretics. Autor of the post: Undefined Although pH itself Post Date: Wed, 15 Oct 2008 17:31:13 +0000 Refractoriness. Many factors must be involved in the phenomenon of refractoriness. Although pH itself is a determinant of mercurial action at the site of the tubular receptor, other variables play an im-portant role in the overall diuretic response. Autor of the post: Undefined This leads to dilu-tional hyponatremia Post Date: Wed, 15 Oct 2008 17:16:46 +0000 Individ-uals in advanced congestive heart failure may have such low filtration rates that they are unresponsive to mercurials. In addition, vigorous diuretic therapy with restriction of dietary sodium chloride intake may result in the renal loss of sodium chloride with-out a proportional loss of water. This leads to dilu-tional hyponatremia, which may decrease the diuretic response even without concomitant alka-losis. Autor of the post: Undefined A loss of about 2,5% Post Date: Wed, 15 Oct 2008 17:01:15 +0000 Course of Diuresis. Following the parenteral ad-ministration of a mercurial diuretic to a responsive edematous patient, an increase in urine flow is evi-dent within 1 to 2 hours and may persist up to 12 hours. A loss of about 2,5% of the body weight represents an average response. Autor of the post: Undefined Should cumulation occur, the signs Post Date: Wed, 15 Oct 2008 16:48:10 +0000 Extrarenal Actions. The organic mercurials nor-mally exert prominent pharmacodynamic actions only on renal tubular function. Should cumulation occur, the signs and symptoms of systemic mercury poisoning develop. Autor of the post: Undefined Routes of Administration Post Date: Wed, 15 Oct 2008 16:37:48 +0000 An action shared by all mercury preparations is the ability in high concentrations to cause cardiac arrhythmias, including ventricular fibrillation. The cardiac toxicity of the mercurials is the basis of rare, untoward clinical reactions (see below).Routes of Administration. Autor of the post: Undefined Oral administration of a mercurial Post Date: Wed, 15 Oct 2008 16:21:38 +0000 The organic mercurials were in the past given by many routes, but intra-muscular and subcutaneous administration is now almost exclusively used. The intravenous route offers no significant advantage and may precipitate cardiac arrhythmias. Oral administration of a mercurial diuretic is of unpredictable efficacy and is poorly tolerated. Autor of the post: Undefined Approxi-mately 50% of injected mercury Post Date: Wed, 15 Oct 2008 16:02:56 +0000 Absorption, Fate, and Excretion. Organic mer-curials are rapidly excreted by the kidney. Approxi-mately 50% of injected mercury can be recovered in the urine within 3 hours and up to 95% within 24 hours. Autor of the post: Undefined When properly administered even over Post Date: Wed, 15 Oct 2008 15:48:17 +0000 Thus, very little appears in the bowel. Excre-tion is retarded in individuals with impaired renal function. When properly administered even over a span of many years, the mercurials neither accumu-late nor show evidence of toxicity. 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