Extreme diuretic dependence in idiopathic edema: mechanisms, prevention and therapy.
Idiopathic edema patients abusing diuretics are occasionally becoming dependent to such a degree on increasing doses of diuretics that their withdrawal results in severe cardiorespiratory failure, occasionally even pulmonary edema. Two such patients are described and 1 is investigated in depth as to the mechanism of the diuretic abuse-induced excessive tubular avidity for sodium. An extreme diuretic-induced secondary hyperaldosteronism and atrial natriuretic factor suppression, although tapering off when diuretics are stopped, results in a continuous tubular sodium hyper-reabsorption. Since the most affected patient was deprived of the benefits of converting enzyme inhibitors because of their side effects, the only way to partially overcome this condition was a generous combination of several diuretics acting at several segments of the nephron. This contrasted with a similar patient who was relatively well controlled by a converting enzyme inhibitor combined with lower dose diuretics. Diuretic abuse-induced secondary hyperaldosteronism and diuretic resistance are apparently best prevented by converting enzyme inhibitors. When nonpharmacological preventive measures fail, converting enzyme inhibitors are preferable to diuretics as the first-choice treatment of idiopathic edema patients.
Kuchel
O
O
Clinical Research Institute of Montreal, University of Montreal, Que., Canada.
Ethier
J
J
D000328:Adult; D004232:Diuretics / Q000009:adverse effects*; D004351:Drug Resistance; D004487:Edema / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000139:chemically induced / Q000503:physiopathology; D011654:Pulmonary Edema / Q000139:chemically induced / Q000503:physiopathology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000628:therapy
D004232:Diuretics