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Principles of Heart Failure Pharmacotherapy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Erika L. Hellenbart, Stephanie Dwyer Kaluzna, Robert J. DiDomenico
Loop diuretics are used to reduce pulmonary congestion, peripheral edema, and other signs and symptoms of fluid retention. Loop diuretics bind to the translocation pocket on the extracellular surface of the sodium-potassium-chloride cotransporter-2 (NKCC2) in the ascending limb of the loop of Henle to block sodium, chloride, and water reabsorption.52 Intravenous bolus administration of loop diuretics reduces preload within 5 to 15 minutes, presumably by venodilation initially, with peak urinary flow by way of sodium and water excretion occurring within 30 minutes.53
Acute coronary syndromes
Published in Henry J. Woodford, Essential Geriatrics, 2022
Appropriate lifestyle advice includes stopping smoking, taking exercise, modifying diet and weight control. A statin is usually indicated (see page 49). An echocardiogram is recommended following ACS to help plan further management. For people with a left ventricular ejection fraction of 40% or less, a beta-blocker and an ACE inhibitor or angiotensin receptor blocker are indicated (see Chapter 17). Beta-blockers may be prescribed for most people following ACS but data suggesting a benefit come mainly from the pre-reperfusion era.12 Blood pressure control may be required (see Chapter 18). All people should be considered for enrolment in a cardiac rehabilitation programme.24 Loop diuretics may be required for acute heart failure. Nitrates are only indicated if there is residual angina. Doses of medications may need to be adjusted in frail older people to reduce the risk of adverse effects.2
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Because they have been shown to variably increase total renal blood flow, loop diuretics are often administered to patients with oliguric renal insufficiency, in the hope of promoting diuresis and improving GFR and renal perfusion. While diuretic administration may convert oliguric ARF to non-oliguric ARF, there is no evidence that this treatment can ameliorate renal function or improve the outcome of patients with ARF [11].
Association of early postoperative serum magnesium with acute kidney injury after cardiac surgery
Published in Renal Failure, 2023
Chao Xiong, Sheng Shi, Liang Cao, Hongbai Wang, Lijuan Tian, Yuan Jia, Min Zeng, Jianhui Wang
In addition, the potential effect of use of loop diuretics was tested. Preoperative loop diuretics were given in 2.3% of the study cohort while loop diuretics were used in 4.0% of patients after surgery but before the first postoperative serum magnesium measurement. The association between serum magnesium and AKI remained statistically significant after accounting for the use of loop diuretics as covariates in the multivariable logistic regression model (Supplemental Table 6). Another post hoc analysis excluding patients with no available preoperative serum creatinine measurements confirmed the findings from the main analysis (Supplemental Table 7). Lastly, early postoperative serum potassium was not a significant predictor of AKI (adjusted OR, 1.03 per 1 mmol/L increase; 95% CI, 0.90–1.17; p<.692 when serum magnesium considered as a continuous variable; and adjusted OR, 1.03 per 1 mmol/L increase; 95% CI, 0.91–1.17; p<.641 when serum magnesium considered as a categorical variable) and the results were consistent with the main analysis with early postoperative serum potassium as an additional potential confounding variable (Supplemental Table 8).
Concomitant rapidly progressive glomerulonephritis and acute rheumatic fever after streptococcus infection: a case report
Published in Paediatrics and International Child Health, 2022
Suwanna Pornrattanarungsi, Sudarat Eursiriwan, Yupaporn Amornchaicharoensuk, Chutima Chavanisakun, Ornatcha Sirimongkolchaiyakul
Generally, high-dose corticosteroid treatment is controversial in the management of RPGN owing to APSGN [6]; nevertheless, pulse methylprednisolone with subsequent tapering to treat valvular inflammation secondary to recurrent ARF was prescribed as this strategy restricts deterioration of renal function. The RPGN resolved gradually without long-term complications. With regard to the choice of antihypertensive medication for concomitant kidney and heart disease, a loop diuretic is usually the first-line medication to control hypertension in glomerulonephritis. However, hydralazine was prescribed as the second medication because it acts as an arteriolar vasodilator which reduces peripheral vascular resistance and increases stroke volume and cardiac output. This helps to control both blood pressure and volume overload from mitral and aortic regurgitation.
Clinical pearls in hospital nephrology
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abdurrahman Hamadah, Tibor Fulop, Kamel Gharaibeh
This patient presents with decompensation of her heart failure. Loop diuretics are an essential component of the management of heart failure. Oral furosemide has variable bioavailability with a range of 10–100% (average 50%) with wide variability [4,5]. The peak natriuretic response for furosemide is seen within 3 h after administration [6]. As such, prompt and timely assessment of response to diuretic is essential. Measurable clinical parameters should be used in making dose adjustments to loop diuretics such as urine output and accurate weight (standing scale). Lack of timely communication between the clinician and bedside nurse about response to diuretics leads to significant delays in timely adjustment of diuretic dose and frequency. Although restriction of salt intake and other measures such as a thiazide diuretic may become necessary, ensuring adequate diuresis takes precedence in this significantly fluid overloaded patient.