Diuresis

• the process of ridding the body of fluids through the
• increased production of urine and the excretion of water and electrolytes

Diuresis

• to decrease fluid volume in pathologic conditions in
• which the body cannot self-regulate fluid volume effectively

• conditions include edema, congestive heart failure (CHF), pulmonary edema, hypertension, and
• kidney disorders.

renal reabsorption of sodium and promote its excretion in water.

The various types of diuretics work differently in the body.

sodium and water retention

cardiac work load and decreases tissue perfusion.

• back up into the lungs, affecting breathing and gas
• exchange

Smallest unit in the kidneys that produce urine

blood come through and gets ride of waste products, ions, and some electrolytes, Filtration

lot of sodium and chloride are reabsorbed. Most happens here so diretics that work early on are more effective

water is permeable it leaves tubule and comes out into nephron

more manipulation of sodium choloride

another way ions are brought back into the body or out. Water in loop of henle are done very passively

65% NaCl reabsorption

20% NaCl reabsorption

10% NaCl reabsorption

1-5% Na+ and K+

◦Furosemide

◦Hydrochlorothiazide (HCTZ)

◦Mannitol

–Spironolactone

–Triamterene

Work in the loop of Henle to inhibit the reabsorption of sodium and chloride

Exert a powerful effect of fluid and electrolyte balance

Called high-ceiling diuretics

• It inhibits the sodium chorlide and stay in the urine. Fluid will be pulled in to stay in the urine and goes out.
• High-ceiling= powerful effect, works early on

bumetanide (Bumex), ethacrynic acid (Edecrin), and torsemide (Demadex)

• Potent diuretic, effective reducing peripheral edema from CHF, pulmonary edema, hepatic and
• renal diseases, including nephrotic disease.

Used in the treatment of HTN; first choice over thiazides in patients with pre-existing renal disease, because, unlike thiazides, it does not decrease glomerular filtration rate.

Inhibits the reabsorption of sodium, chloride, and water in the ascending loop of Henle.

Has some effect in the proximal and distal tubules.

• Adverse effects are related to fluid or electrolyte
• imbalance, ototoxicity, dehydration, hypotension, hypokalemia, hyperglycemia, hyperuricemia, low
• calcium and magnesium levels

Digoxin, antihypertensives, lithium, NSAIDS

Excretion of sodium, chloride, potassium, magnesium, calcium and water increases.

Increase blood glucose, low-density lipoprotein, total cholesterol, uric acid and triglyceride levels.

Monitor weight, I and O, BP

• Pregnancy Category C,
• Potassium rich diet,
• s/s electrolyte imbalance,
• change position slowly

• works by manipulating potassium. These drugs
• loose potassium.

• think of salt,
• when sodium levels are down lithium is reabsorbed, sodium is excreted ,
• lithium is not excreted correctly and can get to toxicity

• undermine effect of prostaglandis.
• NSAIDS, if boy is taking them for pain pain relief is caused by prostaglandis.
• If prostaglandis is altered it effects diuresis

decrease and manage dilation constriction in vessels so change position slowly

10 minutes—cardiac arrest has been reported

• rapid IV administration, therefore, 20-40 mg of IV
• should be given over at least 1 to 2 minutes to decrease risk of ototoxicity

The thiazides comprise the largest group of diuretics.

They are related structurally to the antibacterial sulfonamides.

The prototype thiazide diuretic is hydrochlorothiazide (HCTZ).

• chlorothiazide (Diuril),
• methyclothiazide (Euduron),
• chlorthalidone (Hygrotin),
• indapamide (Lozol)
• metolazone (Zaroxolyn).

Manages HTN alone or with other drugs

Also used in treating edema

Diabetes insipidus

Acts in the distal tubule and possibly in the diluting segment of the ascending loop of Henle

Increases the excretion of sodium and chloride in the distal convoluted tubule by slightly inhibiting the ion pumps that work in sodium and chloride reabsorption

A weak diuretic effect, because most of the sodium is reabsorbed before the distal tubule

• mostly due to the effects of fluid loss or imbalance,
• dehydration, hypokalemia, hyperglycemia

Digoxin, lithium, BP meds, NSAIDS

ototoxicity

Increases excretion of potassium, bicarbonate, and magnesium and decreases the excretion of calcium

Water-soluble vitamins also are lost

May decrease glomerular filtration rate and increase BUN

Monitor renal status, hepatic status, blood glucose levels, lipid, and uric acid levels

• severe renal impairment, hepatic coma, and hypersensitivity to the drug or to sulfonamide
• antibiotics

Check allergy to sulfa, Pregnancy category B

70-110

sodium and water excretion in the distal tubule; at the same time, potassium is not excreted; rather, it is reabsorbed

weak diuresis and antihypertensive effects when used alone

combination with loop and thiazide diuretics to minimize potassium loss because they work synergistically with other diuretics

not working and its renal failure

Kidney disease

• Male: 0.5-1.5
• female: 0.6-1.2,
• if you are muscular yo have a lot of protien and these levels are altered. Clearance is more sensitive number

• Males: 90-137
• Females: 88-128

7-20

Hyperkalemia

spironolactone (Aldactone)

◦triamterene (Dyrenium)

◦amiloride (Midamor)

• distal tubule to increase sodium and water loss and to
• retain potassium

• hypertension,
• edema,
• heart failure,
• PCOS,
• acne in women,
• premenstrual syndrome

• testosterone synthesis, which leads to altered
• estrogenic and androgenic (think male hormones) activity;

a major use is in diagnosing and treating primary hyperaldosteronism

hyperkalemia, impotence, menstrual irregularities, and gynecomastia

In cases of hyperkalemia, sodium polystyrene sulfonate (Kayexalate) may be given orally or rectally.

imbalance of sex hormones, male pattern baldness, trunkal obestiy, a lot of facial hair are common

breast production in males

amiloride (Midamor),

Non Aldostrone antagonist

Used to manage edema and hypertension; typically used with other diuretics because it allows potassium to be reabsorbed and sodium to be excreted

• Inhibits transport of sodium in the distal tubules
• independent of aldosterone;
• this causes increased loss of sodium, chloride, water, bicarbonate, and calcium;
• the drug promotes the retention of potassium and magnesium

Adverse effects related to electrolyte imbalance, particularly hyperkalemia which may be fatal

Nausea, vomiting, leg cramps, dizziness

ACE inhibitors, potassium supplements

• Potassium
• BP,
• weight

potassium, potassium salt substitutes

• Increase osmotic pressure and pull fluid into the vascular space; are not reabsorbed by the
• tubules and so prevent water reabsorption; also prevent the reabsorption of sodium and chloride

Type of sugar

• glycerin (Osmoglyn), isosorbide (Ismotic), and
• urea (Ureaphil)

Major uses include preventing and treating ARF, reducing intracranial pressure in cerebral edema, reducing intraocular pressure when other drugs have not worked, and promoting excretion of toxic substances in urine

Create diuresis by increasing blood osmolality which attracts fluid from other compartments (third spacing, cerebral fluid, intraocular fluid)

Heart failure, pulmonary edema, renal failure, fluid and electrolyte imbalance, dehydration

Lasix may prevent rebound fluid retention

I and O, electrolytes and serum osmolality, BUN and Crt.

s/s heart failure, renal failure

IV, administer with filter needle

• Glycerin (Glycerol):
• Isosorbide (Ismotic)
• Urea (Ureaphil)

• An osmotic agent give orally to reduce intraocular pressure before ophthalmic surgery and during
• acute glaucoma attacks.

Used to provide short-term reduction of intraocular pressure before and after intraocular surgery, and to interrupt acute attacks of glaucoma

Administered by IV infusion

Used to decrease intracranial pressure and to reduce intraocular pressure

aquesous humor is lymph for the eye, causes pressure on the eye, if firm humor is increased

everything is fine size wise but there is tooo much aqueous humor

sits really tight , aqueous humor goes….iris and pupil sit too close to the cornea ***