Abstract
Diuretics are amongst the most prescribed medications in both the inpatient and outpatient
settings. They are used extensively in diverse disease states including heart failure,
acute and chronic kidney disease, cirrhosis, and diseases of excess capillary permeability
such as sepsis, malignancy, and malnutrition. All are characterized by total body
sodium overabundance which commonly manifests as edema. The use of diuretics is however
not bereft of complications. These complications frequently limit the correction of
hypervolemia, resulting in continued patient suffering and frustration for the clinician.
In this review, we employ a case-based approach to discuss three common challenges
encountered during diuretic therapy: diuretic resistance that characterizes the nephrotic
syndrome, diuretic-induced metabolic alkalosis, and diuretic-associated hyponatremia.
We empower the clinician to effectively meet these challenges by providing a mechanistic
understanding of these complications and their solutions.
Keywords
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Article info
Publication history
Published online: April 22, 2022
Accepted:
April 15,
2022
Received:
July 12,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
