Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
Diuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2equence of extracellular fluid (ECF) volume expansion. Edema occurs when dietary' sodium intake exceeds renal Na excretion and is seen in a variety of disorders including heart failure, cirrhosis, and nephrotic syndrome. In each of these conditions, the total body sodium and water content is elevate Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2d: therefore. aside from treating the underlying disease, reducing sodium intake via modifications in diet is the first intervention in the approach tEbook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
o treating edema. Water restriction is usually not necessary when the underlying disease is mild and is usually only recommended when hyponatremia supDiuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2s are powerful drugs that are capable of rapidly improving life-threatening conditions such as acute pulmonary edema, theyA.R. Subramanya. M.D.Department of Medicine. Renal-Electrolyte Division, University of Pittsburgh School of Medicine.S832 Scatfe Hall, 35») Terrace St.Pittsburgh, PA 15261. USAD. Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2H. Ellison. M.D.(H)Division of Nephrology and Hypertension.Department of Medicine. Oregon Health and Science University. 3181 sw Sam Jackson Park Rd,Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
Portland, OR 97239. USA e-mail: ellisond@ohsu.eduare obviously not perfect. Each class bears its own host of clinical side effects and chronic diuretiDiuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2tarium of pharmacologic agents permits the rational management of these conditions. allowing the clinician to tailor therapy to the specific needs of his or her patients.The purpose of this chapter is to review the classes of diuretic agents and their mechanisms of action and to discuss their role i Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2n treating edema. Both generalized approaches and treatment of specific edematous states are discussed. Finally, we address the issue of diuretic resiEbook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
stance and treatment options for this complex problem.Diuretic Classes"Diuretic" is derived from the Greek word dioure-tikos. which means "to promote Diuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2 that promote solute-free urinary water excretion, however, has necessitated a novel scheme of diuretic classification. Most of the diuretics that are used in clinical practice are natriuretics; i.e.. they increase urine volume byinhibiting specific sodium transport pathways at defined anatomic site Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2s along the nephron. Osmotic diuretics, in contrast, do not have a precise molecular target, and primarily force diuresis byD.B. Mount et al. (eds.).Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
Core Concepts in the Disorders of Fluid. Electroly tes and Acid-Base Balance. DOI 10.1007/978-1 -4614-3770-3_6. Springer Science+Business Media New YoDiuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2de suppress sodium reabsorption in the proximal tubule. The loop diuretics (e.g.. furosemide, torsemide. bumetanide) inhibit sodium chloride reabsorption in the thick ascending limb of the loop of Henle. Distal convoluted tubulenatriuretics such as thiazides and thiazide-like diuretics inhibit NaCI Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2reabsorption in the early and late distal convoluted tubule. Collecting duct natriuretics inhibit electro-genic sodium transport in the cortical colleEbook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
cting duct and the late distal tubule. Consequently the sites of action of DCT and collecting duct natriuretics overlap slightlyaltering the osmotic pDiuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2ssin-mediated renal water reabsorption.NatriureticsNatriuretics are by far the most frequently used class of diuretics and are among the most commonly prescribed dings (source: IMS Health). These agents promote a solute and water diuresis by inhibiting the movement of sodium from the tubular lumen t Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2o the blood. Four general subclasses of natriuretics primarily act on different sites of the nephron to facilitate sodium and waterexcretion. As notedEbook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
in Fig. 6.1. these nephron segments are responsible for reabsorbing different fractions of the filtered sodium load, and each segment plays its own iDiuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2 filtrate, while more distal segments ••fine-tune" the urinary sodium content by reabsorbing smaller fractions of the total sodium load in a tightly regulated fashion. The molecular targets and anatomic sites of action of specific agents define many of their clinical properties, including their ther Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2apeutic uses, side effects, and chronic effects on nephron adaptation. Commonly used natriuretics and key pharmacologic aspects of their clinical useEbook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2
are summarized in Table 6.1.Table 6.1 Commonly used natriureticsDiuretic classMaximum change in urinary fractional excretion of sodium1 (%)Oral dose rDiuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conse Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2onCarbonic anhydrase inhibitors45052Acetazolamide125-3752h1008-12 h45086NoRenal (100%)Loop natriuretics30Furosemide20-3200.5-2 h506-8 h0.5-1MinimalRenal, fecalTorsemidc5-2000.5-1 h80-1006h44961Yes (80 %)RenalBumetanide0.5-100.5-1 h80-1004-6 h1-1.5YesRenalEthacrynic acid25-4000.5 h10012 h1Yes (30%)Re Ebook Core concepts in the disorders of fluid, electrolytes and acid base balance: Part 2nal, fecalDistal convoluted mbule natriuretics45058Diuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conseDiuretic Therapy6Arohan R. Subramanya and David H. EllisonIntroductionExcluding regional factors or lymphatic obstruction, edema is the clinical conseGọi ngay
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