Pharmacologic Approaches to Electrolyte Abnormalities in Heart Failure.
Electrolyte abnormalities are common in heart failure and can arise from a variety of etiologies. Neurohormonal activation from ventricular dysfunction, renal dysfunction, and heart failure medications can perturb electrolyte homeostasis which impact both heart failure-related morbidity and mortality. These include disturbances in serum sodium, chloride, acid-base, and potassium homeostasis. Pharmacological treatments differ for each electrolyte abnormality and vary from older, established treatments like the vaptans or acetazolamide, to experimental or theoretical treatments like hypertonic saline or urea, or to newer, novel agents like the potassium binders: patiromer and zirconium cyclosilicate. Pharmacologic approaches range from limiting electrolyte intake or directly repleting the electrolyte, to blocking or promoting their resorption, and to neurohormonal antagonism. Because of the prevalence and clinical impact of electrolyte abnormalities, understanding both the older and newer therapeutic options is and will continue to be necessity for the management of heart failure.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA. grodinj@ccf.org.
Justin L
JL
Grodin
D000086:Acetazolamide / Q000627:therapeutic use; D000136:Acid-Base Equilibrium; D002712:Chlorides / Q000378:metabolism; D004232:Diuretics / Q000627:therapeutic use; D004573:Electrolytes / Q000378:metabolism*; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D011108:Polymers / Q000627:therapeutic use; D011188:Potassium / Q000378:metabolism; D017640:Silicates / Q000627:therapeutic use; D012964:Sodium / Q000378:metabolism; D015040:Zirconium / Q000627:therapeutic use
D002712:Chlorides; D004232:Diuretics; D004573:Electrolytes; D011108:Polymers; D017640:Silicates; C568789:patiromer; C003784:zircon; D012964:Sodium; D015040:Zirconium; D000086:Acetazolamide; D011188:Potassium
Electrolytes; Heart failure; Hyperkalemia; Hypochloremia; Hyponatremia; Metabolic alkalosis; Treatment