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In the development ofedema, these Post Date: Thu, 16 Oct 2008 11:48:55 +0000 In the reabsorption of sodium from the more distal portions of the nephron, acid-base balance and adrenocortical steroids also play a role. As a result of normal homeostatic mechanisms the reabsorptive processes adjust themselves so finely that the renal excretion of sodium is normally equiv-alent to oral intake. In the development ofedema, these renal adjustments fail and urinary sodium excretion decreases. Autor of the post: Undefined Sodium chloride is never em-ployed Post Date: Thu, 16 Oct 2008 11:28:59 +0000 This is true regardless of the nature of the primary disease—most commonly, cardiac, renal, or hepatic.Therapeutic Uses. Sodium chloride is never em-ployed as a diuretic agent in the treatment of edema. Autor of the post: Undefined When these are corrected, urinary Post Date: Thu, 16 Oct 2008 11:18:02 +0000 Rather, the restriction of sodium intake is of para-mount importance. Sodium chloride is used primar-ily to treat deficits in extracellular fluid volume or concentration. When these are corrected, urinary excretion usually increases to normal rates. Autor of the post: Undefined It can-not be taken orally Post Date: Thu, 16 Oct 2008 11:00:54 +0000 Sodium bicarbonate may be useful in nonedema-tous states for the purposeful alkalinization of the urine in order to promote the excretion of certain weak organic acids, including such drugs as sali-cylate, or to enhance the solubility of certain drugs in the urine and thus prevent crystalluria.Sodium sulfate has very little use as a clinical diuretic for the mobilization of edema fluid. It can-not be taken orally because it is not absorbed and acts as a cathartic. Autor of the post: Undefined Solutions of sodium sulfate undergo complex Post Date: Thu, 16 Oct 2008 10:47:14 +0000 When it is given parenterally, the augmentation of urine volume is primarily the result of the excretion of the administered salt and water. The renal tubule has only a limited capacity to reabsorb the sulfate ion.Solutions of sodium sulfate undergo complex re-actions with calcium and other divalent cations. Autor of the post: Undefined POTASSIUM SALTSIn the past, potassium salts Post Date: Thu, 16 Oct 2008 10:30:58 +0000 Sul-fate diuresis is associated, therefore, with a marked rise in divalent cation excretion. This has been used as a basis for treating hypercalcemia and possibly radiostrontium poisoning (Walser et al, 1961).POTASSIUM SALTSIn the past, potassium salts were employed to a limited extent as diuretics. Autor of the post: Undefined As a result, variable degrees Post Date: Thu, 16 Oct 2008 10:14:45 +0000 However, they were not very effective for the mobilization of edema fluid and are no longer used for this purpose. Many of the newer diuretics increase the excretion not only of sodium but of potassium as well. As a result, variable degrees of potassium depletion may develop. Autor of the post: Undefined Taken together, these three characteristics Post Date: Thu, 16 Oct 2008 9:59:21 +0000 Under these conditions, the administration of potassium salts is for the purpose of correcting deficits.OSMOTIC DIURETICSThe term osmotic diuretic is generally used for certain nonelectrolytes that have the fol-lowing attributes in common: (1) they are freely filterable at the glomerulus; (2) they undergo limited reabsorption by the renal tubule; and (3) they are pharmacologically inert by conventional criteria. Taken together, these three characteristics permit the administration of such agents in sufficiently large quantities to contribute significantly tothe osmolality of the plasma, the glomerular filtrate, and the tubular fluid. Autor of the post: Undefined However, a sugar such Post Date: Thu, 16 Oct 2008 9:43:43 +0000 Their action within the kidney depends primarily upon the concentration of osmotically active particles in solution. In addition, most osmotic diuretics are selected because of their resistance to metabolic alteration. However, a sugar such as glucose will act in a similar manner if its concentration becomes excessively high in the plasma and, as a consequence, also in the tubular fluid. Autor of the post: Undefined This generalization is subject Post Date: Thu, 16 Oct 2008 9:32:55 +0000 Mechanism of Diuretic Action. When there is a significant increase in the amount of any osmotically active solute in the voided urine, this is usually accompanied by an increase in urine volume. This generalization is subject to quantitative modification by several factors, including the compensatory effects of the rate of release of the antidiuretic hormone (ADH), the magnitude of positive or negative free-water production, and the exact mechanisms by which solute excretion is increased {see Figure VIII-2, page 814). 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