title: Use, misuse and abuse of diuretics.
abstract: Resolution of edema requires a correct interpretation of body fluids-related renal function, to excrete the excess volume while restoring systemic hemodynamics and avoiding renal failure. In heart failure, the intensive diuresis should be matched by continuous fluids refeeding from interstitium to plasma, avoiding central volume depletion. The slowly reabsorbed ascites cannot refeed this contracted volume in cirrhosis: the ensuing activation of intrathoracic receptors, attended by increased adrenergic and Renin release, causes more avid sodium retention, producing a positive fluid and Na balance in the face of continuous treatment. High-dose-furosemide creates a defect in tubular Na causing diuresis adequate to excrete the daily water and electrolyte load in Chronic Renal Failure. Diuretic treatment requires care, caution and bedside "tricks" aimed at minimizing volume contraction by correctly assessing the homeostatic system of body fluids and related renal hemodynamics.
authors.affiliation: Università del Piemonte Orientale, Medicina Interna, Novara, Italy. Electronic address: ettore.bartoli@hotmail.it.
authors.forename: Ettore
authors.initials: E
authors.lastname: Bartoli
authors.affiliation: Università del Piemonte Orientale, Medicina Interna, Novara, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Università del Piemonte Orientale, Medicina Interna, Novara, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Sola
authors.affiliation: Università del Piemonte Orientale, Medicina Interna, Novara, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Castello
authors.affiliation: Università del Piemonte Orientale, Medicina Interna, Novara, Italy.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Sainaghi
authors.affiliation: Università del Piemonte Orientale, Medicina Interna, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Smirne
mesh_terms: D001201:Ascites / Q000188:drug therapy; D004232:Diuretics / Q000009:adverse effects* / Q000145:classification* / Q000627:therapeutic use*; D004487:Edema / Q000188:drug therapy*; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D006929:Hyperaldosteronism / Q000139:chemically induced; D007010:Hyponatremia / Q000139:chemically induced; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D008103:Liver Cirrhosis / Q000188:drug therapy; D010953:Plasma Volume; D014882:Water-Electrolyte Balance / Q000187:drug effects
chemical_list: D004232:Diuretics
keywords: Diuretics; Edema; Hyponatremia; Plasma volume; Renal failure; Renal pathophysiology