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Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The diuretic response to loop diuretics appears within a few minutes after i.v. administration, and within 30–60 min after oral administration. The effect does not last over 2 h after IV injection, and 6 h after oral administration. The half-life is prolonged in patients with renal and liver insufficiency, and in premature and term neonates. Furosemide is the most commonly used diuretic in children. Torasemide has the same effect as furosemide, but its half-life is longer [19]. Loop diuretics cross the placental barrier and are secreted in breast milk. Loop diuretics are the most potent natriuretic agents, also markedly increasing CP> K+, Ca++ and Mg++ excretion [17]. They remain active in patients with advanced renal failure.
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Loop diuretics are one of the most commonly used classes of diuretic, with furosemide being an example of this group. They act on the loop of Henlé in the nephron, where they inhibit the action of the Na-K-2Cl co-transporter in the thick ascending limb. The result is less sodium being extracted from the renal filtrate and less water reabsorbed from the loop of Henlé and the collecting duct. Remember, as water will always follow sodium, if less sodium is reabsorbed, then less water is reabsorbed, with more being lost through the urine. Furosemide has an additional action, blocking the vessel-constricting response to angiotensin and noradrenaline and increasing the secretion of vasodilating prostaglandins, resulting in vasodilation. Therefore, a common side effect of furosemide is hypotension (a decrease in BP) as well as an increased urine output (diuresis). For this reason, it is used as an anti-hypertensive in those with chronic kidney disease in combination with beta-blockers and angiotensin converting enzyme (ACE) inhibitors (Williams et al. 2018). Unfortunately, the use of loop diuretics results in loss of sodium, chloride and potassium, so serum electrolytes require close monitoring.
Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Currently, there is no consensus as to the time of furosemide administration. Studies vary from: 15 minutes prior to renal acquisition (F -15).the beginning of the acquisition (F 0).10 minutes after acquisition started as a fixed time for administration (F +10, F +15).20 minutes after acquisition started (F +20).
What do Spanish registries report about worsening events in chronic heart failure? Needs and challenges
Published in Expert Review of Cardiovascular Therapy, 2023
Juan Luis Bonilla Palomas, José Ignacio Morgado García de Polavieja, Miriam Padilla Pérez, Diego Rangel-Sousa, Antonio Castro Fernández, José López Aguilera, Carolina Ortiz Cortés, Francisco Torres Calvo
Thus, those strategies aimed at preventing decompensation are mandatory. A structured follow-up, in HF units, together with the benefits of telemedicine, as an alternative to face-to-face follow-up in some cases, allow for greater optimization of HF treatment [14,19,20]. In this context, the determination of natriuretic peptides may be very useful in the early identification of worsening HF. For example, it has been reported that even in asymptomatic patients, elevations of natriuretic peptides negatively impact on prognosis [23,24]. Furthermore, biomarker-guided management could be useful to reduce health care costs for HF treatment, as it would allow an early optimization of HF therapy [25]. On the other hand, the outpatient dose of furosemide before acute HF admission may predict long-term prognosis and should alert us about the high risk of HF hospitalization and the need for the early adjustment of HF therapy [26]. Importantly, telemedicine may have a potential impact to detect early signs of HF worsening and should be promoted in the management and follow-up of these patients in order to prevent recurrent HF hospitalizations [27].
Current evidence for pharmacologic therapy following stage 1 palliation for single ventricle congenital heart disease
Published in Expert Review of Cardiovascular Therapy, 2022
Meredith C. G. Broberg, Ira M Cheifetz, Sarah T Plummer
Diuretics are one of the most common medication types prescribed in the interstage period [54]. The goal of stage 1 palliation is adequate, but restrictive, pulmonary blood flow via a shunt or banded bilateral branch pulmonary arteries. However, most patients have excessive pulmonary blood flow early with the goal/anticipation that it will become more restrictive over time as the infant grows. Thus, diuretics are frequently prescribed to treat pulmonary congestion for symptomatic relief. However, there are no randomized trials supporting or discouraging their use in this patient population. Adverse effects of furosemide use in children with congenital heart disease include increased fracture risk [71], nephrocalcinosis [72, 73], and ototoxicity [74, 75]. Diuretic use, including loop diuretics and thiazide diuretics, also can lead to electrolyte disturbances and kidney dysfunction.
Management of type 2 diabetes mellitus in older adults: eight case studies with focus SGLT-2 inhibitors and metformin
Published in Acta Clinica Belgica, 2022
Gulistan Bahat, Nezahat Muge Catikkas, Mehmet Akif Karan, Mirko Petrovic
The second patient was a 79-year-old female suffering from 30 years history of T2DM, hypertension, ischemic heart disease with CABG 13 years ago, congestive heart failure, chronic obstructive pulmonary disease, stage 3a chronic renal failure (eGFR >45 ml/min/1.73 m2), knee osteoarthritis affecting her daily living. Her treatment regimen included insulin (basal-bolus treatment; 3 times 10 U regular crystallized insulin and 30 U insulin glargine), exenatide 2 times 10 µg, aspirin 100 mg, diltiazem 2 times 30 mg, furosemide 40 mg, rosuvastatin 5 mg, trospium 25 mg. She was frail and had UI as a geriatric syndrome. Pre-prandial blood glucose levels were between 190 and 260 mg/dl and post-prandial between 250 and 300 mg/dl. She was dependent only on bathing among basic daily living activities, and independent in instrumental activities (cooking, shopping, housework, and transport). We considered the patient at high risk for recurrent ischemic heart disease and diabetic renal disease. We initiated empagliflozin 10 mg and closely followed for possible side effects. In the follow-up, furosemide need decreased to over daily schedule and had better control of blood pressure, heart failure, and glycemia. We increased empagliflozin to 25 mg to ensure maximum protection. No side effects took place in the follow-up. She is now at 15 months of therapy.