Makindo Medical Notes

Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart FailureLoop Diuretics | Entresto Sacubitril with Valsartan | Ivabradine | Furosemide | Angiotensin Converting Enzyme Inhibitors | Cardiac Resynchronisation Therapy (CRT) Pacemaker |

Diuretics should not be used on a long-term basis to treat simple gravitational oedema. This will usually respond to increased ambulation, raising the legs and support stockings.

About: Always check the BNF link here

• Loop diuretics: See BNF or equivalent for UpToDate prescribing advice
• These are potent diuretics useful for the rapid excretion of Salt, other electrolytes and water. Often used in the acute treatment of Left ventricular failure.

Chemistry

• 3-(butylamino)-4-phenoxy-5-sulfamoylbenzoic acid.
• Heavily bound to albumin.

Mode of action

• Block primarily the absorption of sodium and chloride not only in the proximal and distal tubules but also in the loop of Henle.
• Effect depends on renal clearance so may be diminished in older patients

Indications

• Acute LVF: Bumetamide 1-2 mg given as a single iv dose
• Congestive cardiac failure: Bumetanide 1 mg OD to 2 mg BD
• Hypertension: Bumetanide 1 mg OD often with an ACEI or ARB. Not recommended as a single agent
• Fluid overload - Liver failure: Bumetanide 1 mg OD
• Nephrotic syndrome: Bumetanide 1 mg OD
• Treat hypercalcaemia, Treat hyperkalaemia: rarely used but IV dose may be given

Dose range:You must check with BNF or drug datasheet

Contraindications

• Avoid with ototoxic drugs
• Monitor renal function and electrolytes
• Hypokalaemia can increase Digoxin toxicity

Side effects

• Elderly patients are particularly susceptible to the side-effects of diuretics.
• Volume depletion and orthostatic hypotension and falls especially in elderly
• Hypokalaemia and metabolic alkalosis, Hypomagnesaemia
• Hypocalcaemia and Hypercalciuria and calcium excretion
• Hyperuricaemia (can lead to gout)
• Ototoxicity - tinnitus especially avoid with aminoglycosides
• Diabetes and Hyperglycaemia

Interactions

• Digoxin toxicity as causes hypokalaemia
• Can cause lithium toxicity through its actions on renal clearance