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Loop Diuretic


Presentation

  • The time delay by which symptoms of pancreatitis presented following administration of loop diuretics suggests an immunologic pathway.[ncbi.nlm.nih.gov]
  • Abstract A case is presented in which a 34-year-old man with renal insufficiency and malignant hypertension develops acute pancreatitis with abdominal symptoms and hyperamylasemia after being treated with loop diuretics (furosemide and bumetanide).[ncbi.nlm.nih.gov]
  • Diuretic resistance is a clinical problem with similar presentation despite diverse and multiple etiologies. Although the exact incidence is not known, diuretic resistance occurs frequently and can increase the length of hospitalization.[ncbi.nlm.nih.gov]
  • Theoretical advantages are described, current knowledge reviewed, and an outline of a prospective study presently underway is given.[ncbi.nlm.nih.gov]
  • We present a case of a patient with a history of pancreaticoduodenectomy who had development of beriberi by diuretic use. A 68-year-old man was referred to our hospital because of pretibial pitting edema, foot numbness, and gait disturbance.[ncbi.nlm.nih.gov]
Hypotension
  • Among patients with a normal concentration of serum creatinine there was no correlation between serum PTH and blood pressure but in those receiving hypotensive medication serum PTH was appropriately twofold greater than in those not taking hypotensive[ncbi.nlm.nih.gov]
  • It should be used together with other hypotensive drugs.[skepticfiles.org]
  • We conclude that changes in baroreflex sensitivity are not responsible for the hypotensive effects of this drug and that resetting of the reflex arc is likely to be due to physiological adaptation rather than to any direct drug effect.[ncbi.nlm.nih.gov]
  • Torsemide has infrequent, mild, and transient adverse effects; among the most common are orthostatic hypotension, fatigue, dizziness, and nervousness.[ncbi.nlm.nih.gov]
Orthostatic Hypotension
  • Torsemide has infrequent, mild, and transient adverse effects; among the most common are orthostatic hypotension, fatigue, dizziness, and nervousness.[ncbi.nlm.nih.gov]
  • Adverse Reactions * CV: Hypovolemia and hypotension: rapid diuresis, especially in the patients receiving other hypotensive agents, may result in severe orthostatic hypotension, syncope, and other manifestations of hypovolemia.[skepticfiles.org]
Tinnitus
  • Secondary end points were electrolyte imbalance, change in creatinine levels, tinnitus or hearing loss, and days of hospitalization. RESULTS: Ten randomized controlled trials with 518 patients were identified.[ncbi.nlm.nih.gov]
  • Ototoxicity Main complaint is the fullness of ear, tinnitus, hearing loss and disturbance of ionic balance of endolymph. As Na K 2Cl- is present in internal ear, so ionic balance is also disturbed, leading to ototoxicity.[howmed.net]
  • Other adverse reactions include paresthesias, tinnitus, taste alteration, and metabolic acidosis (especially in elderly and kidney disease). Mannitol has complex effects on electrolytes.[openanesthesia.org]
  • This may be limited to tinnitus and vertigo, but may result in deafness in serious cases.[en.wikipedia.org]
  • […] excessive bicarbonate loss Hyponatraemia and dehydration, with hypokalaemia Gastrointestinal reactions (such as anorexia, nausea and diarrhoea) Postural hypertension, vertigo, headache Fatigue, weakness, lethargy Hyperglycaemia; increased uric acid Tinnitus[nursingtimes.net]
Muscle Cramp
  • Muscle Cramps or Weakness This may be linked to potassium levels, so check with your doctor about a potassium supplement. Feeling Thirsty If you feel thirty try sucking on a towel soaked in ice water or a sugarless hard candy.[womens-health-advice.com]
  • cramps (loop diuretics) Ringing in the ears (loop diuretics) Low sodium, potassium, and/or magnesium levels in the blood (loop diuretics) High potassium levels in the blood (potassium-sparing diuretics) Enlarged breasts in men (Aldactone and Inspra)[everydayhealth.com]
  • This can make you tired or weak or give you muscle cramps or a headache. It's rare, but your heart may speed up (over 100 beats a minute) or you might start throwing up because of a dangerously low potassium level.[webmd.com]
Leg Cramp
  • Symptoms of low potassium levels include fatigue and leg cramps. Low levels can also affect heart rhythms. As the name implies, potassium sparing meds preserve potassium levels.[womens-health-advice.com]
Incontinence
  • During the whole period of treatment patients were keeping bladder diaries where records on frequency and volume of daily urinations, episodes of urgency (EU), episodes of incontinence (EI) and other symptoms were kept.[ncbi.nlm.nih.gov]

Workup

Hyponatremia
  • Additionally, copeptin concentrations did not predict future development of hyponatremia.[ncbi.nlm.nih.gov]
  • The loop diuretic would cause hypovolemic hyponatremia, the mechanism involves a decrease in both TBW and sodium, but with a relatively greater decrease in sodium.[forums.studentdoctor.net]
  • Another limiting factor to therapy with loop diuretics can be a slowly developing hyponatremia . This can only be alleviated by reducing fluid intake and giving lower doses of the loop diuretic.[flexikon.doccheck.com]

Treatment

  • CONCLUSIONS: Loop diuretics still prove useful in HF treatment, but risk-benefit analysis of these agents in the treatment of ADHF requires a well-designed prospective study.[ncbi.nlm.nih.gov]
  • The use of diuretics in the treatment of ascites is associated with several side effects , including prerenal azotemia, hepatic encephalopathy, and electrolyte and acid-base disorders.[ncbi.nlm.nih.gov]
  • Functional performance of lower urinary tract (LUT) at enrollment and at the end of the treatment was evaluated using ICIQ-SF questionnaires.[ncbi.nlm.nih.gov]
  • We report that the loop diuretic drugs bumetanide and furosemide used in the treatment of hypertension are GPR35 agonists.[ncbi.nlm.nih.gov]
  • RESULTS: A total of 43 received a continuous infusion and 39 were assigned to bolus treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Poor diuretic response will be associated with less decongestion and an adverse prognosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT02638142 . 2017 The Authors.[ncbi.nlm.nih.gov]
  • AIMS: Few studies have reported the impact of high-dose loop diuretics at discharge on prognosis in Japanese patients with heart failure (HF).[ncbi.nlm.nih.gov]
  • Conclusions Elevated AVP levels in patients with heart failure who received LD therapy were associated with a poor prognosis. Loop diuretics may induce non-osmolar AVP release, which can worsen heart failure.[ncbi.nlm.nih.gov]
  • This study sought to determine the dose-dependent relation between loop diuretic use and HF prognosis. A cohort of 1,354 patients with advanced systolic HF referred to a single center was studied.[ncbi.nlm.nih.gov]
  • Therefore, it is not clear if continuous infusion is better than intermittent boluses in terms of decongestion, maintenance of renal filtration function and prognosis.[clinicaltrials.gov]

Etiology

  • Diuretic resistance is a clinical problem with similar presentation despite diverse and multiple etiologies. Although the exact incidence is not known, diuretic resistance occurs frequently and can increase the length of hospitalization.[ncbi.nlm.nih.gov]
  • Etiology was ischemic in 32% and mean left ventricular ejection fraction was 42%.[ncbi.nlm.nih.gov]

Epidemiology

  • Short-term metabolic & epidemiologic studies and various clinical trials suggest a connection between thiazide diuretic use and the development of type 2 diabetes.[healthy-ojas.com]
Sex distribution
Age distribution

Pathophysiology

  • Magnesium deficiency: pathophysiologic and clinical overview. Am J Kidney Dis 24: 737–752, 1994. 2. Dorup I. Magnesium and potassium deficiency.[health.cvs.com]
  • […] antiarrhythmic drugs. 6 iii) Nonsteroidal anti-inflammatory agents reduce the efficacy of thiazide diuretics. 6 iv) Thiazides can increase the blood levels of lithium. e) Clinical Uses Thiazides can be used to treat edema associated with a variety of pathophysiologic[uky.edu]
  • Pathophysiology of sodium and water retention in heart failure. Cardiology 96, 122–131 (2001). 9. Levin, E. R., Gardner, D. G. & Samson, W. K. Natriuretic peptides. N. Engl. J. Med. 339, 321–328 (1998). 10. Harris, P. J., Thomas, D. & Morgan, T. O.[nature.com]
  • Pathophysiology of sodium and water retention in heart failure . Cardiology 96 , 122–131 (2001). 9. Levin, E. R. , Gardner, D. G. & Samson, W. K. Natriuretic peptides . N. Engl. J. Med. 339 , 321–328 (1998). 10. Harris, P.[nature.com]

Prevention

  • […] and magnets cotransporter preventing positive potentional from forming, preventing reabsoption of Ca2 and Mg2 Side effects Falling ice cream and magnets, banana indicate hypocalcemia, hypomagnesia and hypokalemia Loud gong indicates ototoxicity Blue kidney[cram.com]
  • The drug prevents the reabsorption of sodium from the blood filtrate at this location.[brighthub.com]
  • Extra precautions should be taken immediately following a loop diuretic drug change in an effort to prevent falls. Copyright 2012 John Wiley & Sons, Ltd.[ncbi.nlm.nih.gov]
  • Authors' conclusions: There was insufficient evidence to determine whether premedicating people undergoing blood transfusion with loop diuretics prevents clinically important transfusion-related morbidity.[cochrane.org]

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