Things that Bug me 1 – improper use of diuretics

This month on our VA ward team we have had 3 admissions that involved complications of over diuresis for systolic dysfunction.  We also see patients who do not have adequate diuresis. Diuretics greatly help symptoms in patients with systolic dysfunction and volume overload.  But diuretics are primarily symptom relief medications. I often ask students and residents to write this sentence, memorize it, and use it: The purpose of diuretic therapy in systolic heart failure is render the patient not wet, but not to make the patient dry. The idea here is that we should only give enough diuretic therapy to relieve symptoms.   Diuretics do not help these patients unless that have volume overload. Here is the section on diuretics from the 2013 ACC/AHA guideline: 7.3.2.1. Diuretics: Recommendation Class I Diuretics are recommended in patients with HFrEF who have evidence of fluid retention, unless contraindicated, to improve symptoms. (Level of Evidence: C) Diuretics inhibit the reabsorption of sodium or chloride at specific sites in the renal tubules. Bumetanide, furosemide, and torsemide act at the loop of Henle (thus, the term loop diuretics), whereas thiazides, metolazone, and potassium-sparing agents (eg, spironolactone) act in the distal portion of the tubule.427,428 Loop diuretics have emerged as the preferred diuretic agents for use in most patients with HF. Thiazide diuretics may be considered in hypertensive patients with HF and mild fluid retention because they confer mor...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs