Management of loop diuretic resistance in the intensive care unit

Asare, Kwame Kumi

doi:10.2146/ajhp090068

Cited by 32 publications

(22 citation statements)

References 41 publications

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“…This also happens when furosemide is suddenly withdrawn (106). Dietary Na ϩ is a critical factor (43): during high Na ϩ intake, the compensatory increase in Na ϩ reabsorption between doses can lead to neutral Na ϩ balance; to achieve a negative Na ϩ balance, a dietary Na ϩ restriction is required (7,165).…”

Section: What Determines the Braking Phenomenon And Is There A Fundammentioning

confidence: 99%

“…Several mechanisms could lead to enhanced reabsorption in other segments than the loop of Henle during long-term use of furosemide. Empirically this has led to the notion of diuretic synergism: thiazides are used to block the adapted sodium reabsorption in the distal nephron to enhance the diuretic effect of chronic furosemide therapy (7,43).…”

Section: What Determines the Braking Phenomenon And Is There A Fundammentioning

confidence: 99%

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Everything we always wanted to know about furosemide but were afraid to ask

Huang

Mees

Vos

et al. 2016

American Journal of Physiology-Renal Physiology

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Huang X, Dorhout Mees E, Vos P, Hamza S, Braam B. Everything we always wanted to know about furosemide but were afraid to ask. Am J Physiol Renal Physiol 310: F958 -F971, 2016. First published February 24, 2016 doi:10.1152/ajprenal.00476.2015.-Furosemide is a widely used, potent natriuretic drug, which inhibits the Na ϩ -K ϩ -2Cl Ϫ cotransporter (NKCC)-2 in the ascending limb of the loop of Henle applied to reduce extracellular fluid volume expansion in heart and kidney disease. Undesirable consequences of furosemide, such as worsening of kidney function and unpredictable effects on sodium balance, led to this critical evaluation of how inhibition of NKCC affects renal and cardiovascular physiology. This evaluation reveals important knowledge gaps, involving furosemide as a drug, the function of NKCC2 (and NKCC1), and renal and systemic indirect effects of NKCC inhibition. Regarding renal effects, renal blood flow and glomerular filtration rate could become compromised by activation of tubuloglomerular feedback or by renin release, particularly if renal function is already compromised. Modulation of the intrarenal renin angiotensin system, however, is ill-defined. Regarding systemic effects, vasodilation followed by nonspecific NKCC inhibition and changes in venous compliance are not well understood. Repetitive administration of furosemide induces short-term (braking phenomenon, acute diuretic resistance) and long-term (chronic diuretic resistance) adaptations, of which the mechanisms are not well known. Modulation of NKCC2 expression and activity in kidney and heart failure is ill-defined. Lastly, furosemide's effects on cutaneous sodium stores and on uric acid levels could be beneficial or detrimental. Concluding, a considerable knowledge gap is identified regarding a potent drug with a relatively specific renal target, NKCC2, and renal and systemic actions. Resolving these questions would increase the understanding of NKCCs and their actions and improve rational use of furosemide in pathophysiology of fluid volume expansion. extracellular fluid volume; natriuresis; renal function; chronic kidney disease; heart failure DIURETICS BLOCKING THE Na ϩ -K ϩ -2Cl Ϫ cotransporter (NKCC) have an important place in the treatment of fluid overload, specifically in the context of kidney disease and heart failure (64). Of the drugs that inhibit the NKCC2 in the loop of Henle (furosemide, bumetanide, torsemide, ethacrynic acid), furosemide is most commonly applied (66) and Ͼ40 million prescriptions are dispensed every year in the USA (66a). However, many uncertainties remain about intrarenal and systemic actions of furosemide, including its two main targets NKCC1 and NKCC2.Clinically, there are a number of undesirable consequences of the use of furosemide, of which the pathophysiological mechanisms have not been sufficiently investigated. Furosemide has been associated with worsening of kidney function in patients treated for volume overload admitted for acute heart failure (104) and even glomerular filtration rate (GFR) ...

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Section: What Determines the Braking Phenomenon And Is There A Fundammentioning

confidence: 99%

Section: What Determines the Braking Phenomenon And Is There A Fundammentioning

confidence: 99%

Everything we always wanted to know about furosemide but were afraid to ask

Huang

Mees

Vos

et al. 2016

American Journal of Physiology-Renal Physiology

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“…Furthermore, if diuretic resistance occurs, the addition of a thiazide diuretic may produce a better result and be more cost-effective in achieving diuresis in patients with volume overload whose hemodynamic status is stable. 2 Our study had some limitations. Because the study was retrospective, incorrectly recorded information and uncontrolled confounders are possible.…”

Section: Discussionmentioning

confidence: 90%

“…Compared with bolus administration, continuous infusion of furosemide may improve diuresis with fewer adverse effects. 1,2 However, furosemide resistance may occur in critically ill patients despite alterations in dosing regimens, making it difficult to achieve goals for fluid output.…”

Section: Selection Of Patientsmentioning

confidence: 99%

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Effect of Albumin on Diuretic Response to Furosemide in Patients With Hypoalbuminemia

Doungngern

Huckleberry

Bloom

et al. 2012

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Examine the effect of albumin on the diuretic effect of furosemide. 2. Correlate findings of various studies related to the sequential administration of albumin and furosemide. 3. Identify study limitations and opportunities for future research related to administration of furosemide and albumin.To read this article and take the test online, visit www.ajcconline.org and click "CNE Articles in This Issue." No fee for AACN members.

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Hypertension Drug Therapy

Hui

2020

Advances in Experimental Medicine and Biology

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Management of loop diuretic resistance in the intensive care unit

Cited by 32 publications

References 41 publications

Everything we always wanted to know about furosemide but were afraid to ask

Everything we always wanted to know about furosemide but were afraid to ask

Effect of Albumin on Diuretic Response to Furosemide in Patients With Hypoalbuminemia

Hypertension Drug Therapy

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