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Drugs

, Volume 1, Issue 2, pp 141–165 | Cite as

Diuretics II: Clinical Considerations

  • John L. Anderton
  • Priscilla Kincaid-Smith
Review Article

Summary

The successful use of diuretics depends upon a knowledge of their mode of action, their potency, and their side-effects. The four basic groups of diuretics which cover most situations are: (i) the thiazides, (ii) ethacrynic acid or frusemide, (iii) spironolactone or triamterene, (iv) mannitol.

The thiazides have a moderate diuretic action and are useful in any oedematous state where a gradual removal of salt and water is required. Mild to moderate cardiac, cirrhotic, and renal oedema respond well to thiazide administration, and the thiazides are useful in systemic hypertension, diabetes insipidus, and in the treatment of hypertension and oedema associated with pregnancy.

Ethacrynic acid and frusemide are potent diuretics and are useful in managing patients with severe resistant oedema, in acute left ventricular failure, in chronic renal failure when very high doses may be required, in eclampsia, and in the management of patients who have taken an overdose of drugs.

Spironolactone or triamterene are useful in conditions where there is hyperaldosteron-ism, particularly primary aldosteronism when surgery is not possible, and in cirrhosis. They are occasionally useful in cardiac and nephrotic oedema in association with other diuretics.

Mannitol is a useful osmotic diuretic particularly as a prophylactic agent against acute tubular necrosis and in the management of patients who have taken an overdose of drugs. Mannitol is occasionally useful in inducing a diuresis in patients with severe resistant oedema.

The side-effects of diuretic agents fall into two groups: (i) biochemical or metabolic effects shared by most diuretics and (ii) miscellaneous effects particular to individual diuretics. The biochemical disturbances include acute and chronic sodium depletion, due to the ingestion of diuretics while on a restricted sodium intake; chronic dilutional hyponatremia due to the overloading of the body with salt free fluids; hypokalemia due to the ingestion of diuretics without potassium supplements; and in the presence of renal failure, hyperkalemia due to the ingestion of potassium supplements, spironolactone or triamterene. Abnormalities in carbohydrate, uric acid and calcium metabolism are occasionally seen with most diuretics.

It should be remembered that the use of diuretic agents is only part of the total management of the patient, and that every attempt should be made to influence the primary pathology of the condition being treated.

Key Words

Diabetes insipidus Drug poisoning Drug reactions adverse Eclampsia pre-eclampsia Heart failure Hypertension Liver cirrhosis Nephrotic syndrome Pregnancy Renal failure 

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Copyright information

© Adis International Limited 1971

Authors and Affiliations

  • John L. Anderton
    • 1
  • Priscilla Kincaid-Smith
    • 2
  1. 1.Department of TherapeuticsRoyal InfirmaryEdinburghScotland
  2. 2.Medical Renal Unit, Royal Melbourne Hospital and Department of MedicineUniversity of MelbourneVictoriaAustralia

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