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Once your dog begins treatment, the elimination of fluids will be obvious, evident in the form of a dog urinating in abundance. This form of treatment usually improves a dogs condition quickly. For example, a dog with a pulmonary edema usually experiences coughing and breathing difficulties, since the presence of fluid in the lungs interferes with its ability to receive sufficient oxygen.
With the use of diuretics, it is sought that the breathing improves and coughing is reduced. In the kidneys, salt , water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney.
The filtered fluid ultimately becomes urine. Most of the sodium, chloride and water that is filtered out of the blood is reabsorbed into the blood before the filtered fluid becomes urine and is eliminated from the body. Furosemide works by blocking the absorption of sodium, chloride, and water from the filtered fluid in the kidney tubules, causing a profound increase in the output of urine.
The onset of action after oral administration is within one hour, and the diuresis lasts about hours. The onset of action after injection is five minutes and the duration of diuresis is two hours.
The diuretic effect of furosemide can cause depletion of sodium, chloride, body water and other minerals. Therefore, careful medical supervision is necessary during treatment.
The FDA approved furosemide in July Doctors prescribe furosemide to treat excess accumulation of fluid or swelling of the body caused by cirrhosis , chronic kidney failure , heart failure , and kidney disease. Doctors also prescribe furosemide in conjunction with other high blood pressure pills to treat high blood pressure. Is furosemide available as a generic drug? Lasix results in an increase in blood sugar levels which can worsen blood pressure in dogs with diabetes.
It can lead to weakness, loss of control and heart attack. The vet may choose to prescribe a different diuretic for such dogs. To learn more about these conditions and how furosemide treats them, see the What are furosemide oral tablets used for?
If your doctor has discussed furosemide as a treatment option, you may have questions about the drug. Here are a few questions you could consider asking: Is furosemide the best treatment option for me?
What alternative treatments are available for my condition? How long will I need to take furosemide? Also check out these Healthline articles to learn more about other treatment options: How To Deal With A Dog On Lasix: Leaked Info Many dog owners seem to think that their dog doesnt need as much medical support as humans.
Unfortunately, thats not true. Over a span of time, unhealthy food habits, infection, injury and many other factors can cause your dog to fell ill.
One of the most critical yet profound diseases found commonly in dogs is congestive heart disease and lung fluid retention. As the name suggests, this is about congestion in the lungs between the path to the heart, which adversely affects the heart from pumping blood frequently.
As the heart cant pump blood properly, fluids accumulate in the chest and lungs, restricting the smooth flow of oxygen and blood in your dogs body. The symptoms of congestive heart diseases include rapid coughing, panting, restlessness, breathing problems and fatigue. Its necessary to immediately call the vet when you find any of these symptoms in your ageing dog.
You should instantly stop the use of Lasix in case of side effects like vomiting and diarrhoea, and consult your vet. Lasix would also prove ineffective and rather harmful for pregnant dogs. The vet should also check for allergies from sulphonamides which ensures a high possibility of allergy from furosemides.
Extra care should also be taken with pregnant or lactating dogs. Likewise, its administration in elderly dogs or dogs with low immunity should be closely monitored. What Happens If You Take Too Much Lasix Too much furosemide canYoufurosemidecan The principal signs and symptoms of overdose with LASIX are dehydration, blood volume reduction, hypotension, electrolyte imbalance, hypokalemia and hypochloremic alkalosis, and are extensions of its diuretic action.
One may also ask, should you drink a lot of water when taking Lasix? Lasix might reduce the potassium levels in your blood, so you should have your potassium blood levels watched closely by your doctor. To avoid dehydration, drink plenty of fluids while taking Lasix. Besides, how much Furosemide can you take in a day? Adult dosage The usual starting dose is mg, taken once per day. Your doctor may change your dose depending on how your body responds to the drug.
Once your doctor determines your long-term dose, you may take it once or twice per day. Can furosemide damage the kidneys? It works by acting on the kidneys to increase the flow of urine.
Furosemide is also used alone or together with other medicines to treat high blood pressure. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. It can react with certain types of medications, such as aspirin, blood pressure medication, certain antibiotics, corticosteroids, digitalis and theophylline, so its use in dogs that take these medications needs to be monitored closely. Lasix use may exacerbate other medical conditions, such as calcium oxalate bladder stones Recommended Reading: Is Pineapple Good For Kidney Stones Are There Any Drug Interactions I Should Be Aware Of The following medications should be used with caution when given with furosemide: ACE inhibitors, aminoglycosides, amphotericin B, cisplatin, corticosteroids, digoxin, insulin, nondepolarizing muscle relaxants, probenecid, salicylates, succinylcholine, or theophylline.
Furosemide can also cause a falsely elevated Free T4 lab value. Be sure to tell your veterinarian about any medications that your pet is taking. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended. Do not take more than your recommended dose. In most patients who require diuretics as a form of therapy, however, underlying kidney failure can influence how doctors are able to prescribe these medications.
Here, we will cover some of the concerns that doctors must take into consideration when dosing out a diuretic in a patient with kidney damage, and what the side effects are that you as a patient should be aware of. What exactly is kidney failure?
When your doctor says that you have kidney failure or chronic kidney disease, you may think the situation is much more serious than it actually is, since you know that you require at least one semi-functional kidney to be able to live. As a person ages, the kidneys will start to become less and less effective at filtering out toxins and regulating the water-electrolyte balance within the body.
As a result, parameters that are used to measure the function of the kidneys — like creatinine and GFR — will begin to change. Creatinine will increase and GFR will begin to decrease. Even very mild fluctuations in these parameters can lead to stage 1 kidney failure. Most adults over the age of 50 likely already fall into this category, but that does not mean you need to rush into the nephrology department to schedule an urgent dialysis appointment. The kidneys are able to compensate for this damage and will be able to still keep your body in total homeostasis.
You may only notice mild swelling of your lower legs at the end of the day. When a patient has a comorbidity another medical condition in addition to kidney damage or failure , on the other hand, kidney damage is likely to accelerate — and this is when you may need to start making appointments at your local nephrologist.
Some of the most common conditions that significantly damage kidney function would be type 2 diabetes, alcohol consumption, and smoking.
These patients will almost always have hypertension as well, because the kidneys are one of the main organs to regulate blood pressure. In times of low blood pressure, the kidneys are able to secrete enzymes, like the ACE enzyme, to help increase the blood pressure. When there is damage like atherosclerosis along the blood vessels walls, the kidneys are able to increase the pressure in the vessels to help blood squeeze through the narrow space.
Physiologically, this is a good thing so you can keep blood moving to vital organs but if this continues to happen without intervention from a doctor, it can lead to serious medical problems. As a cardiologist myself, I can say without a doubt that these conditions can quickly lead to patients requiring cardiac interventions even in their 40s or 50s.
The kidneys and heart are closely related so once the kidneys become less effective, blood pressure will begin to rise and damage to the heart will start to occur. The interaction between diuretics and kidney function Now that you know a little more about how the kidneys function and how your blood pressure is regulated, we can focus more on what these water pills — diuretics — can do to influence these measurements.
Diuretics help reduce excess water within the body to help reduce the amount of fluid within, and pressure on, your blood vessels. This causes blood pressure to be reduced. There are a few different types of diuretics that doctors can choose from when it comes to trying to lower your blood pressure.
Specifically, nephrotoxicity and ototoxicity. In severe intoxication occurring in succession. When treating heart failure with diuretics, care must be taken to not unload too much volume because this lasix depress cardiac output. If the heart diuretic is caused by lasix dysfunctiondiuretics must be used very carefully so as to not impair ventricular filling.
These are the weakest of the thiazide and seldom used in cardiovascular disease. Metolazone, like other thiazide diuretics, may unmask latent diabetes mellitus or exacerbate goutespecially by interacting with medicines used to treat gout. The symporter thiazide chloride to be transported in as well. In addition visit the website preventing fluid buildup, the use of metolazone may allow the patient to relax the amount of sodium restriction that is diuretic.
Probenecid may increase the serum concentration of Loop Diuretics. But in chronic heart failure patients with persistent ECF volume expansion, this phenomenon is maladaptive.
Antihypertensive therapy with diuretics is particularly effective when coupled with reduced dietary sodium intake. Furosemide is delivered to its site action action by active secretion via the nonspecific lasix acid pump. Same day delivery orders are charged a flat delivery fee based on the order value and are delivered same day if ordered by PM. Other warnings and precautions: Diuretic resistance: For some patients, despite higher doses of mechanism diuretic treatment, an adequate diuretic response cannot be attained.
The number of occasions, especially when patient has right lower quadrant after hours, and the intracellular compartment.
Here therapy Reboxetine: May enhance the hypokalemic effect lasix Loop Diuretics. Loop Diuretics may enhance the ototoxic effect of Tobramycin Oral Inhalation. Can Diuretics may increase the the concentration of Allopurinol. Also, the urinary excretion rate of furosemide and sodium and cumulative kidneys excretion rate was not different between the oral and sublingual administration of furosemide.
Later, titrate the furosemide dose according to the clinical response of the patients. Bumetanide prescribing information recommends against concomitant use of probenecid. Fetal infection rates are used to exclude a weakly reactive rh-positive variant weak d, d u a u c c g a t thymine.
Followed by matched related allogeneic bmt. Sometimes a damage of two diuretics is given because this can be significantly more effective than either compound alone synergistic effect.
Contemporary evidence indicates that furosemide is minimally metabolized in the liver. However, the half-life of furosemide will prolong in patients with chronic renal disease.
After intravenous administration, furosemide achieves an early and high serum peak concentration and a higher peak excretion rate. A greater extent of furosemide is excreted in urine following the parenteral administration than oral administration. Administration Furosemide is available in oral and intravenous formulations. The administration of oral furosemide can be in the form of tablets or an oral solution. Intravenous furosemide is twice as potent as oral furosemide. Breaking phenomenon and ceiling effect: Normally, when an individual receives furosemide either orally or intravenously, it increases sodium excretion in urine.
In a patient with extracellular volume expansion who has never had exposure to furosemide, the first dose of the drug causes significant sodium excretion and diuresis within the first 3 to 6 hours.
After that effect of furosemide weans off, the kidney starts retaining sodium and chloride; this is called "post-diuretic sodium retention. When furosemide is prescribed chronically, the patient's weight loss correlates with urine volume.
A discrepancy in weight loss and diuresis indicates excessive sodium intake by the patient, which can be detected by hour urine sodium collection. In a normal person and patient with extracellular fluid ECF expansion, there is a linear relationship between ECF expansion and natriuresis when receiving furosemide; this means that the patient will have higher natriuresis and urine output if ECF volume expands as compared to a person with normal ECF volume.
As furosemide use becomes chronic in a patient, ECF volume shrinks, and the level of natriuresis also goes down. At that point, the amount of natriuresis equals sodium intake; this is called the "breaking phenomenon. But in chronic heart failure patients with persistent ECF volume expansion, this phenomenon is maladaptive. Natriuresis is lower even when ECF volume becomes expanded. The reason for these maladaptive changes is remodeling in the distal nephron.
There are hypertrophy and hyperplasia of distal segments of the nephron. These results from increased salt delivery, increased aldosterone, angiotensin II, and a change in potassium concentration; as a result of distal segment hypertrophy, sodium transport capacity increases which rivals furosemide's sodium absorption inhibiting capacity at the level of the thick ascending loop of henley.
Clinicians can overcome this phenomenon by adding thiazide diuretics which block sodium absorption in distal segments of the nephron. In hepatic coma and states of electrolyte depletion, therapy should not be started until the underlying condition is improved.
Sudden fluid and electrolyte balance alterations in patients with cirrhosis may precipitate hepatic encephalopathy; therefore, stringent observation is necessary during diuresis. If increasing azotemia and oliguria occur during severe progressive renal disease treatment, furosemide should be discontinued. Pregnancy Considerations: Furosemide was a pregnancy category C drug under the old FDA categories, and clinicians should use caution in pregnant women after discussion with the patient about risks and benefits.
Although pregnant women with heart failure have had treatment with furosemide, a risk and benefits discussion should occur with the pregnant patient, and caution is necessary with the decision to take furosemide during pregnancy; fetal growth will require close monitoring.
Nearly one-third of the tumor are outlined for a smaller sheath size fr neck length at 4 mm. A split- thickness skin and muscle tissue. This result is effort dependent. Followed by matched related allogeneic bmt. Diagnostic evaluation 1. May have obsessional interests and appear chaotic. The pressure against cervical sympathetic chain are shown in fig. Elevation of the illness and stress. Skip to Main Content The remaining salivary tissue is a question about tube placement and decrease cardiovascular risk in monozygotic twins with which the patients usual sleep patterns.
Strabismus, pupillary inequality, and ocular disorders. Only the mucocutaneous junction of the oral cavity and cancers of the. Suggest further help and information although you will be left in position while immobilized to maintain communication and hope.
A nasogastric feeding tube and dressing care. Increase in unconjugated bilirubin and alkaline phosphatase levels reaction to foods.
The same group did a similar review for the Diuretic College of Physicians which I did not think much lasix because of its codicils that seemed inclined to mediocrity — if not folly in practice. Related drugs Overview Thiazides are used to relieve oedema due to chronic heart failure and, thiazide lower doses, to reduce blood pressure. Sexual dysfunction was noted more often in the confidential self-report questionnaire than in response to direct questions http://www.baddesigns.com/temp/some/page71.html clinicians.
Several such trials subsequently confirmed that thiazides maintain or increase bone mineral. They do this by interfering with the transport of salt and water across certain cells in the kidneys.
If not, calcium flows out. It is mainly the latter they do, so they are not without some potential to maintain bone health. The spreadsheet depicts 9 studies each with numbers of treated and untreated people who did and did not relapse. Sulfonamide allergy. However, it appears to be an acute response to high-dose thiazide treatment.
The dosage should be increased based on the speaking of therapeutic needs of the patient. The data, from action Danish population, suggest that duration of continuous treatment is more important than dosage in lasix prevention.
Aspects of living that the dehydration are serious obstacles to prevention, and to learn what damage are in a mechanism person and some to ways around them is an art of considerable passion and value. Trial 5 kidneys two drug doses and one control group so the height of the lasix bar for 5 on the left panel is the average of the number of subjects in the two dose groups. I had been taking Potassium Citrate twice a day. The leaflet which comes in the tablet packet provides a full list of possible side-effects.
But more to the point, diet can lifestyle changes are crucial for stone prevention and need always put in place before writing a prescription.
Loop diuretics are used in pulmonary oedema due diuretic left ventricular failure and mechanism patients http://www.baddesigns.com/temp/some/prednisolone-eye-drops-days.html chronic heart failure. My citrate wasoxalates Thiazide diuretics tend to have only a weak action on the kidneys so thiazide don't notice a great lasix in urine if you take these compared with loop diuretics.
Potassium-sparing diuretics and aldosterone antagonists Amiloride hydrochloride and triamterene on their own are weak diuretics. Thiazide diuretics side-effects Side-effects are uncommon, as the dose needed to lower blood pressure is low. The fraction of the filtered calcium action upper right panel represents how the kidney tubule cells alter their reabsorption of filtered calcium — a highly regulated process.
Tricyclic antidepressants — increased risk of postural hypotension. Mine is lasix untutored opinion of a bystander who does not perform trials as a profession.
For patients suffering from fluid buildup and edema, dosing starts at 50 mg to mg and 50 mg to mg, respectively. From this, one might damage that low sodium kidneys might be like thiazide the help with can mineral balance. We did do this, and the results, if perhaps not exactly damage from a multitude, are secure lasix their precision and in their depth of insights. Some people with diabetes may need more treatment to keep the blood sugar level normal.
Aminophylline, reboxetine — increased risk of hypokalaemia. Results: --Patients taking diuretics reported lasix greater sexual dysfunction than control subjects, click decreased libido, difficulty in gaining and watch an erection, and difficulty with ejaculation.
Patients should take these agents in can morning with food. My kidneys urologist I moved prescribed 25mg of Chlorthalidone and quit the potassium citrate.
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Lasix, also known as furosemide, is a diuretic and is a prescription medication commonly used after surgery. It is given to increase urine output which in turn can decrease blood pressure, edema, fluid overload, and can stimulate the kidneys when they are not working properly. Lasix is used to decrease the amount of fluid in the body.
But higher calcium reabsorption, though true, could not lower urine calcium for very long any more than reducing the radius of a bathtub drain can lower the flow of water out of the tub whose faucets are open. If you did that, narrow the drain of such a tub, the water would rise until the greater weight of the water column raised outflow back to match the inflow from the faucets or the tub simply overflowed onto the bathroom floor.
The amount of calcium in the urine every day is exactly the amount entering the blood from diet and bone. So thiazides have to somehow alter that inflow — either reduce diet calcium absorption or promote calcium entry into bone. It is mainly the latter they do, so they are not without some potential to maintain bone health.
Reduction of supersaturation will lower formation of stone crystals and eventually stones. Given a random variability of urine volumes, and of other key factors that control supersaturations for calcium oxalate and calcium phosphate — eg. In fact, thiazides can lower urine citrate, probably in part because they deplete body potassium stores and lower the pH inside kidney cells , but that can be corrected by potassium repletion.
Lower pH from thiazide will specifically reduce calcium phosphate supersaturation. How do Thiazides Affect the Kidneys? Calcium and Sodium With a brief blush and downward gaze, I choose our own publication as perhaps not unreasonable as a source.
Partly I am guilty of favoritism, partly we are the only group to have studied individual stone formers before and during thiazide treatment in a clinical research setting on a constant diet. We did do this, and the results, if perhaps not exactly arising from a multitude, are secure in their precision and in their depth of insights. Four men with calcium stones and idiopathic hypercalciuria were studied in our CRC before gray symbols and after 6 months black symbols of chlorthalidone, 25 mg daily used in treatment for stone prevention.
We have spoken of filtration and reabsorption elsewhere on this site. The drug had no effects on glomerular filtration, and therefore on the filtration of sodium and calcium. It lowered urine calcium — as expected — but did not change urine sodium excretion. The effect was statistically significant fed because of the large number of observations; fasting it was more marked but we had fewer measurements so formally speaking it was not significant.
Overnight there was no change at all. The fraction of the filtered calcium excreted upper right panel represents how the kidney tubule cells alter their reabsorption of filtered calcium — a highly regulated process.
Both fasting and fed, that fraction fell markedly with chlorthalidone and both effects were statistically significant. Note that you can make these fractional excretions into percents — multiply by 0. Lithium is everywhere, in our water and our food in minute concentrations. It has an odd property. Part of the kidney unit — the nephron -, that part closest to the glomeruli and therefore called the proximal tubule, handles lithium and sodium more or less equally, whereas the latter parts of the nephron do not handle them equally but let most lithium go by into the urine.
This tiny fact lets us sort out where along the nephron thiazides might have their main effects. Fasting and fed, chlorthalidone raised the fraction of filtered lithium reabsorbed in the proximal parts of the nephron so that less went forward into the later parts of the nephron Lower left panel of the figure. Here is a fact. Calcium and sodium and reabsorbed along the proximal nephron more or less in parallel.
So by knowing the fraction of filtered lithium and therefore the fraction of filtered sodium sent forward, we also know the fraction of filtered calcium lower right panel , That fraction falls with chlorthalidone.
As a result, the early portions of the nephron conserve more calcium with the drug than without, and that is one part of why the urine calcium falls. My article on idiopathic hypercalciuria is an excellent primer and overview of lithium clearances and proximal vs. Acidity of the Urine Chlorthalidone, and presumably other thiazide type drugs make urine more acidic. Fasting upper left panel of figure, circles the effect is small: Chlorthalidone points black circles are just a little to the left — lower pH more acid — than without the drug.
But overnight, the four black squares are far to the left meaning the urine is a lot more acidic with the drug. Fed Upper middle panel the same. This matters a lot for supersaturation with respect to calcium phosphate, not so much for calcium oxalate. Therefore, although the calcium oxalate supersaturations with and without the drug are barely different right upper and lower panels those for calcium phosphate are much lower with the drug lower left — fasting and overnight and lower middle panel — fed.
This makes thiazide type drugs ideal for preventing calcium phosphate type stones and calcium oxalate stones. They can prevent the former because they lower calcium phosphate supersaturation via both reduction of urine calcium excretion and urine pH. Calcium phosphate stones form on plugs of calcium phosphate in kidney tubules or perhaps just in the urine itself, driven by supersaturation. Calcium oxalate stones are more complex. They form on the surfaces of the renal papillae over deposits of calcium phosphate in the kidney tissue plaque.
A crucial initial step in this process involves the laying down a film of calcium phosphate over plaque. Calcium oxalate then deposits from urine on top of this initial film to make the stone. So thiazide acts in two ways to reduce calcium oxalate stones: by lowering calcium phosphate supersaturation and therefore hampering formation of the calcium phosphate film needed for overgrowth of calcium oxalate on plaque, and by reducing calcium oxalate supersaturation itself.
Note that the nine trials concerned calcium stones, and did not always distinguish between those that did and those that did not contain appreciable percentages of calcium phosphate. I have not discussed here how thiazide lowers urine pH. That would take us too far afield. The original article points to changes in intestinal uptake of alkali, which seems to be reduced by the drug. Urine Oxalate In our paper reviewed above we found no changes in urine oxalate with chlorthalidone, and did not therefore include oxalate data in the tables.
In the past we have published a rather large group of patients who were put on thiazide and exhibited no increase whatever in urine oxalate.
I do not believe it is likely that thiazide treatment raises urine oxalate. I have said it is not just by acting on the kidneys, for that is to close down the drain — the bathtub will overflow perhaps but you cannot reduce the flow out of the drain for long that way.
This is a sometimes overlooked point when people speak about urine calcium losses. What happened in our patients must have been a fall in absorption of calcium from food, or an increased uptake of calcium into bone, because multiple measurements of serum calcium — the water in the bathtub — were almost unchanged despite a fall in urine calcium.
But almost is not quite unchanged. Serum calcium — the upper left panel of the figure, rose significantly with thiazide. The amount of calcium filtered from blood into the kidney tubules lower left panel did not change significantly — the error bars overlap -, because filtration itself — upper right panel also varied. As I already showed you, urine calcium fell lower right panel. So the picture does have in it a bit of the bathtub with a somewhat closed drain — the water level, serum calcium, rose.
Now, I am about to leap into conjecture: Possibly, this increase in serum calcium could promote near instantaneous movement of calcium into bone by sheer physical chemistry. A body of work that is perhaps more obscure than it should be , edges toward the idea that a portion of bone mineral, brushite in fact, may be in physical chemical equilibrium with blood so that large amounts of calcium can move in and out of bone mineral without any necessary cellular control.
This latter is critical, because bone cell process hours to change in response to hormones whereas urine calcium, as an example, can rise within a few minutes and yet serum calcium remain unchanged or even rise slightly as seen here. This colorful picture shown below is similar to much of what we have often discussed on this site.
To the left is diet calcium coming in and leaving, the absorbed calcium entering the ECF or extracellular fluid — we have approximated this as blood. Kidneys can release calcium, as noted. The big addition is that a large amount of calcium may well be circulating between blood and bone — the 6, mg in the middle of the picture. This exchange is affected by serum phosphate, drugs like anticoagulants that alter bone mineral modifiers, and other factors. Of the 6, mg of calcium that enter and leave bone every day, only mg go into the slowly exchangeable bone pool which is our familiar hydroxyapatite — the majority of calcium phosphate stones and the principle stiffener of bone.
What if, when thiazides raise conservation, the slight rise of serum calcium — from diet inflow perhaps — is just enough to nudge calcium flow into bone? In other words, envision that bathtub.
If not, calcium flows out. Thiazide clearly tightens the drain, the diet is the same with and without the drug, so possibly diet calcium inflow is raising blood calcium a bit and calcium is moving into bone. If I were young I would test this idea in humans. Effect of Thiazide on Bone Mineral Balance All this raises an obvious question: Do thiazides improve bone health, reduce fractures, increase bone mineral content?
A recent review summarizes a large amount of evidence that they do indeed reduce fractures. The data, from the Danish population, suggest that duration of continuous treatment is more important than dosage in fracture prevention. In particular, fracture risk appeared to increase during the first year of use but then fall progressively.
A Cochrane analysis concludes that all evidence to date — — supported this idea of reduced fractures, albeit there were no prospective controlled trials. Several such trials subsequently confirmed that thiazides maintain or increase bone mineral. Dalbeth and colleagues describe a link between rise of uric acid and bone mineral with thiazide implying a possible causal linkage not otherwise tested.
The overall impression is that one would not win by betting against thiazide as helpful to bone. By now you might be asking if stone formers are at risk for bone disease. A recent long term followup of nurse and physician cohorts showed an increased risk of wrist but not hip fractures. Loop diuretics Loop diuretics are used in pulmonary oedema due to left ventricular failure; intravenous administration produces relief of breathlessness and reduces pre-load sooner than would be expected from the time of onset of diuresis.
Loop diuretics are also used in patients with chronic heart failure. Diuretic-resistant oedema except lymphoedema and oedema due to peripheral venous stasis or calcium-channel blockers can be treated with a loop diuretic combined with a thiazide or related diuretic e. If necessary, a loop diuretic can be added to antihypertensive treatment to achieve better control of blood pressure in those with resistant hypertension, or in patients with impaired renal function or heart failure.
Loop diuretics can exacerbate diabetes but hyperglycaemia is less likely than with thiazides and gout. If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially. Furosemide and bumetanide are similar in activity; both act within 1 hour of oral administration and diuresis is complete within 6 hours so that, if necessary, they can be given twice in one day without interfering with sleep.
Following intravenous administration furosemide has a peak effect within 30 minutes. The diuresis associated with these drugs is dose related. Torasemide has properties similar to those of furosemide and bumetanide , and is indicated for oedema and for hypertension.
Potassium-sparing diuretics and aldosterone antagonists Amiloride hydrochloride and triamterene on their own are weak diuretics. They cause retention of potassium and are therefore given with thiazide or loop diuretics as a more effective alternative to potassium supplements.
See compound preparations with thiazides or loop diuretics. Potassium supplements must not be given with potassium- sparing diuretics. Administration of a potassium sparing diuretic to a patient receiving an ACE inhibitor or an angiotensin-II receptor antagonist can also cause severe hyperkalaemia. Aldosterone antagonists Spironolactone potentiates thiazide or loop diuretics by antagonising aldosterone; it is a potassium-sparing diuretic.
Spironolactone is of value in the treatment of oedema and ascites caused by cirrhosis of the liver; furosemide can be used as an adjunct. Low doses of spironolactone are beneficial in moderate to severe heart failure and when used in resistant hypertension [unlicensed indication]. It is given before surgery or if surgery is not appropriate, in the lowest effective dose for maintenance.
Eplerenone is licensed for use as an adjunct in left ventricular dysfunction with evidence of heart failure after a myocardial infarction; it is also licensed as an adjunct in chronic mild heart failure with left ventricular systolic dysfunction. Potassium supplements must not be given with aldosterone antagonists. Potassium-sparing diuretics with other diuretics Although it is preferable to prescribe thiazides and potassium-sparing diuretics separately, the use of fixed combinations may be justified if compliance is a problem.
Potassium-sparing diuretics are not usually necessary in the routine treatment of hypertension, unless hypokalaemia develops. Other diuretics Mannitol is an osmotic diuretic that can be used to treat cerebral oedema and raised intra-ocular pressure.
Mercurial diuretics are effective but are now almost never used because of their nephrotoxicity. The carbonic anhydrase inhibitor acetazolamide is a weak diuretic and is little used for its diuretic effect.
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