Diuretics

Posted by e-Medical PPT Friday, September 7, 2012
Primary effect of diuretics is to increase solute excretion, mainly as NaCl
Causes increase in urine volume due to increased osmotic pressure in lumen of renal tubule.
Causes concomitant decrease in extra-cellular volume (blood volume)
Certain disease states may cause blood volume to increase outside of narrowly defined limits
Hypertension
Congestive heart failure
Liver cirrhosis
Nephrotic syndrome
Renal failure
Dietary Na restriction often not enough to maintain ECF and prevent edema ---> diuretics needed

Types of diuretics and therapeutic uses
Carbonic anhydrase inhibitors (work in proximal tubule)
 Cystinuria (increase alkalinity of tubular urine)
 Glaucoma (decrease occular pressure)
 Acute mountain sickness
 Metabolic alkalosis

Osmotic diuretics (proximal tubule, loop of Henle)
 Acute or incipient renal failure
 Reduce preoperative intraocular  or intracranial pressure

Loop diuretics (ascending limb of loop)
 Hypertension, in patients with impaired renal function
 Congestive heart failure (moderate to severe)
 Acute pulmonary edema
 Chronic or acute renal failure
 Nephrotic syndrome
 Hyperkalemia
 Chemical intoxication (to increase urine flow)

Thiazide diuretics (distal convoluted tubule)
 Hypertension
 Congestive heart failure (mild)
 Renal calculi
 Nephrogenic diabetes insipidus
 Chronic renal failure (as an adjunct to loop diuretic)
 Osteoporosis

Potassium-sparing diuretics (collecting tubule)
 Chronic liver failure
 Congestive heart failure, when hypokalemia is a problem
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