Additional thoughts on diuretics – a followup to the furosemide rant

Yesterday’s screed about loop diuretics initiated more twitter activity than any blog post this year.  Who knew? Several comments bear documenting. Important information on comparative absorption and duration of diuretics – A wonderful long range colleague (you should follow @kidney_boy on twitter) posted this infographic concerning this question on his blog.  This is a most important link. @Ajauseon tweeted this: “aspired to teach ‘evidence-based’ diuresis on CCU this month only to find there isn’t any”  This tweet reminds me that EBM does not work for all questions.  This question – how to get the desired diuresis – benefits more from a physiologic and pharmacologic approach.  We owe our learners the following: Understanding the goal of diuresis – relieve edema that impairs health (especially pulmonary edema) without inducing volume contraction Understand where diuretics work and their relative potency – i.e. loop diuretics generally induce much larger diuresis than thiazides Understand true diuretic resistance Understand the pharmacologic differences within each diuretic class (see comment #1) Quality measures for managing systolic dysfunction include ACE/ARB use, beta blocker use, AICD, Biventricular pacing when necessary, but do not refer to diuretic use and abuse.  Yet my anecdotal experience suggests that we see more admissions for either inadequate diuresis or over aggressive diuresis than the...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs