DIURETICS-GUIDE

SUMMARY

1. Treat edematous patients with heart failure or CKD with a loop diuretic (eg. Frusemide).

2. Treat patients with hypokalemia with spironolactone.

3. Diuretic-induced hypokalemia can be dangerous in patients with cardiac problems and cirrhosis because of the potential for arrhyth­mias (especially if on digoxin) and hepatic coma.

4. Because higher doses only increase side effects, use the lowest diuretic dose needed to achieve the desired effect.

5. In HF & cirrhotic patients, it's best to keep the K > 4 with supplementation or K-sparing drugs.

6. Thiazide diuretics can produce severe hyponatremia in patients with poor solute intake, particularly the elderly.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].