Refractory oedema in congestive heart failure: a contributory role of loop diuretics?
We report a patient with congestive heart failure (CHF) who presented with massive oedema resistant to therapy with maximal doses of loop diuretics, despite an adequate renal function. After a diuretic pause and dietary salt restriction, a conventional dose of furosemide in combination with distally active diuretics induced a prompt weight loss exceeding 30 kg with stable renal function. We suggest that the 'refractory' oedema in this patient was due to a combination of CHF and inappropriate (loop) diuretic therapy in conjunction with a high dietary sodium intake. We conclude that in the absence of hyponatremia and renal failure, even severe oedema may not represent a negative prognostic indicator. The recognition of diuretic-associated mechanisms complicating cardiac oedema is essential to avoid the vicious circle of worsening oedema whilst escalating therapy with loop diuretics.
Department of Internal Medicine (Cardiology), University of Heidelberg, Germany.
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C
Haller
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Salbach
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Katus
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Kübler
D000328:Adult; D004232:Diuretics / Q000627:therapeutic use*; D004351:Drug Resistance; D004487:Edema / Q000188:drug therapy* / Q000209:etiology; D006333:Heart Failure / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D012982:Sodium, Dietary / Q000008:administration & dosage*
D004232:Diuretics; D012982:Sodium, Dietary