The Art and Science of Using Diuretics in the Treatment of Heart Failure in Diverse Clinical Settings

  • Md. Shahidul IslamEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1067)


It is important to understand the rationale for appropriate use of different diuretics, alone or in combination, in different heart failure patients, under diverse clinical settings. Clinicians and nurses engaged in heart failure care, must be familiar with different diuretics, their appropriate doses, methods of administration, monitoring of the responses, and the side-effects. Inappropriate use of diuretics, both under-treatment and overtreatment, and poor follow-up can lead to failures, and adverse outcomes. Adequate treatment of congestion, with rather aggressive use of diuretics, is necessary, even if that may worsen renal function temporarily in some patients. Diuretic treatment should later be titrated down, by early recognition of the euvolemic sate, which can be assessed by clinical examination, measurement of the natriuretic peptides, and when possible, echocardiographic estimation of the left ventricular filling pressure. You need to treat patients, who are truly resistant to the loop diuretics, by administering the diuretics as intravenous bolus injection followed by continuous infusion, and/or by sequential nephron blockade by adding the thiazide diuretics. You need to use the diuretics based on a sound understanding of the pathophysiology of the disease process, the pharmacokinetics and pharmacodynamics of the diuretics, even when strong evidences for your choices might be lacking. Some patients may benefit from injection of loop diuretics together with hypertonic saline, and others from injection of loop diuretics with albumin. Patient education, and regular follow up of the treatment of heart failure patients, in out-patient settings are important for reducing the rates of complications, and for reducing the needs for urgent hospitalizations.


Albumin in heart failure Bumetanide in heart failure Diuretic algorithm in heart failure Diuretic dose in heart failure Diuretic infusion in heart failure Diuretic resistance in heart failure Diuretics in heart failure Hypertonic saline in heart failure Loop diuretics in heart failure Sequential nephron blockade Thiazides in heart failure Torsemide in heart failure 



Financial support was obtained from the Karolinska Institute, Stockholm, Sweden, and the Uppsala County Council, Uppsala University Hospital, Department of Emergency Care and Internal Medicine, Uppsala University, Sweden.

Conflicts of Interests

The author declares that he has no conflicts of interest concerning the publication of this paper.


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Clinical Science and Education, SödersjukhusetKarolinska Institutet, Research CenterStockholmSweden
  2. 2.Department of Emergency Care and Internal Medicine, Uppsala University HospitalUppsala UniversityUppsalaSweden

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