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DIURETICS How do they work? What do they do? WHEN DO I USE THEM? How do I use them?

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Presentation on theme: "DIURETICS How do they work? What do they do? WHEN DO I USE THEM? How do I use them?"— Presentation transcript:

1 DIURETICS How do they work? What do they do? WHEN DO I USE THEM? How do I use them?

2 DEFINITION OF EDEMA The Accumulation of Abnormal Amounts of Extravascular, Extracellular Fluid. ANASARCA: Severe, widely distributed pitting edema.

3 TYPES OF EDEMA LOCALIZED GENERALIZED Inflammation Lymphatic Obstruction Venous Obstruction Thrombophlebitis CARDIAC HEPATIC RENAL NEPHROTIC SYNDROME ACUTE GN CRF IDIOPATHIC Other Cyclic Myxedema Vasodilator-induced Pregnancy-induced Capillary leak syndrome

4 MECHANISMS OF EDEMA FORMATION  IS P cap  cap P IS  alance of Starling Forces Filtration < or = Lymphatic Drainage Filtration > Lymphatic Drainage  o  dema  DEMA (Capillary Permeability)  nterstitial Space

5 CARDIAC EDEMA Diagnosis History of Heart Disease Evidence of Pulmonary Edema Orthopnea SOB Exertional Dyspnea Evidence of Volume Expansion Hepatic Congestion Hepatojugular Reflux Ventricular Gallop Rhythm

6 CARDIAC EDEMA Pathophysiology HEART DISEASE Left Ventricular Dysfunction Right Ventricular Dysfunction Increased Pulmonary Venous Pressure Pulmonary EdemaSystemic Edema Hypotension Renal Na Retention

7 HEPATIC EDEMA Diagnosis History of Liver Disease Diminished CrCl (Normal Serum Cr) Evidence of Chronic Liver Disease Spider Angiomata Palmar Erythema Jaundice Hypoalbuminemia Evidence of Portal Hypertension Venous Pattern on Abdominal Wall Esophogeal Varices Ascites

8 LIVER DISEASE Neurohumoral Activation (Increased “Volume Hormones”) Liver Cirrhosis Increased Pressure in Hepatic Sinusoids Exudation of Fluid Into Peritoneal Cavity Systemic Edema Ascites Renal Na Retention HEPATIC EDEMA Pathophysiology Functional Renal Insufficiency (Hepatorenal Syndrome)

9 RENAL EDEMA Diagnosis History of Renal Disease Evidence of Albumin Loss Narrow, pale transverse bands in nail beds Proteinuria (3+ to 4+) Hypoalbuminuria Renal Imaging Enlarged Kidneys Nephrotic Syndrome or AGN Shrunken Kidneys CRF

10 RENAL EDEMA Diagnosis Nephrotic Syndrome Hyaline Casts Oval Fat Bodies Lipid Droplets/Casts Acute Glomerulonephritis Hematuria Erythrocyte Casts Leukocyte Casts Pyuria Chronic Renal Failure Broad Waxy Casts Urinalysis

11 RENAL EDEMA Pathophysiology RENAL DISEASE Urinary Loss of Albumin Reduced GFR Hypoalbuminemia Altered Starling Forces Systemic Edema Renal Na Retention NEPHROTIC PATHWAY NEPHRITIC PATHWAY

12 CARDIAC Dependent Edema HEPATICRENAL Proteinuria Facial Edema Ascites Hypoalbuminemia Severe Absent Absent/Mil d SevereAbsent/Mil d SevereModerate/MildAbsent Absent/Trace Severe/Moderate ModerateMild Severe

13 IDIOPATHIC EDEMA Diagnosis Women of Childbearing Age Associated with Eating Disorders Dependent Edema Facial Edema Abdominal Bloating 

14 IDIOPATHIC EDEMA Pathophysiology  IS P cap  cap P IS  alance of Starling Forces Filtration > Lymphatic Drainage  DEMA (Capillary Permeability)  nterstitial Space   


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