title: Rational diuretic management in congestive heart failure: a case-based review.
abstract: The pharmacology and pharmacokinetics of diuretics are unique among therapeutic drugs. Knowledge of these principles can be used to great advantage in the management of heart failure, whereas ignoring them can lead to either minor or life-threatening adverse consequences. Two major categories of potential therapeutic problems are diuretic resistance and the development of disturbances in serum potassium and other electrolytes. Inhibition of sodium reabsorption in the loop of Henle or distal convoluted tubule leads to renal potassium wasting, whereas inhibition of sodium reabsorption in the collecting duct (either directly, as with triamterene or amiloride, or through aldosterone antagonism) causes potassium retention. Combining diuretics of different classes, a rational and frequently used strategy to counter diuretic resistance, can be anticipated to balance or magnify these effects, depending on the site of action of the individual drugs.
authors.affiliation: Piedmont Nephrology and Hypertension Associates, PA, 1899 Tate Boulevard South East, Suite 2101, Hickory, NC 28602, USA. richard_paul@charter.net
authors.forename: Richard V
authors.initials: RV
authors.lastname: Paul
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004347:Drug Interactions; D016903:Drug Monitoring; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000009:adverse effects / Q000627:therapeutic use; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000150:complications; D007686:Kidney Tubules, Distal / Q000187:drug effects; D008138:Loop of Henle / Q000187:drug effects; D009399:Nephrons / Q000187:drug effects; D018579:Patient Selection; D012449:Safety; D017673:Sodium Chloride, Dietary / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004232:Diuretics; D017673:Sodium Chloride, Dietary; D005665:Furosemide