Diuretics

1) Introduction to how diuretics work:

Diuretics are drugs that help release excess sodium (salt) and water. Diuretics work by making the kidneys expel more sodium through the urine. In return, sodium carries blood water. This reduces the amount of fluid in the blood vessels, which reduces the pressure on the walls of the arteries. Diuretics are used to treat high blood pressure and the accumulation of fluid in the body that occurs in some diseases, such as congestive heart failure, liver disease and kidney disease. They should be prescribed in conjunction with low-sodium diets and lifestyle changes.

Diuretics are used to treat various diseases. Here are the most common ones.

High blood pressure - many patients with high blood pressure (hypertension) are treated with diuretics. The treatment is particularly effective when combined with low sodium diets. Diuretics act to lower blood pressure, primarily by reducing blood volume; however, some diuretics can lower blood pressure in other ways and at lower doses than necessary to cause an increase in urine production.

Heart failure - By reducing the body's excess fluid, diuretics can relieve the edema (swelling due to excess fluid) that commonly occurs in heart failure. Many heart failure patients are treated with diuretics and a low sodium diet. It is important for heart failure patients who take diuretics to have their salt (electrolyte) levels carefully monitored. Heart failure patients who use diuretics will have to use medications for the rest of their lives.

Renal insufficiency - diuretics are used to treat patients whose kidneys do not function normally, although they can also worsen kidney function at times.

Liver disease - diuretics can help treat liver disease when there is fluid accumulation in the abdomen.

Hypercalcemia - diuretics can treat excessive levels of calcium in the blood.

Diabetes insipidus - this disease is characterized by excessive thirst and elimination of large amounts of urine. Some types of diuretics decrease urine volume in these patients.

Glaucoma - some diuretics can be used to treat this eye disease, where the increased pressure inside the eye causes damage and gradual loss of vision.

Cerebral edema - some diuretics can treat the potentially fatal swelling of the brain caused by bleeding, trauma, illness or surgery.

2) Types of Diuretics:

There are three main types of diuretic medications. Each works in a different way, but all decrease the amount of salt and water in the body, which helps to lower blood pressure.
The choice of diuretic depends on the patient's health and the disease being treated. Different types of diuretics can also be combined into a single pill. Urine flow usually increases within a few hours after the first dose, but diuretics can take several weeks to control diseases such as high blood pressure. Below are the three main types of diuretics.

a) Loop diuretics - Furosemide (Lasix)
They have this name because of the loop-shaped part of the kidneys (Henle loop, ascending portion), which is where they act. Loop diuretics remove a large amount of sodium from the kidneys, increase urine flow and are more powerful than thiazides.
The most famous loop diuretic is furosemide (better known as Lasix). It is the most potent diuretic. To give you an idea, in normal people only 0.4% of the filtered sodium in the kidneys comes out in the urine, the remaining 99.6% goes back into the blood. With the start of furosemide, the excreted sodium jumps to 20%.
Therefore, furosemide is indicated in diseases that present sodium and fluid retention, such as heart failure, cirrhosis, nephrotic syndrome and renal failure. Loop diuretics are also especially useful in emergencies. Although the most common ones are orally, in hospitals they can be administered intravenously to treat patients with a large excess of fluid.
Despite its high power to excrete sodium, furosemide is not a good diuretic for hypertension. It should only be used for this purpose in people who have the diseases mentioned above at the same time.
Furosemide (lasix) should preferably be taken twice a day. Since its effect lasts an average of 6 hours, this should be the ideal time interval between the two shots. If the patient takes the first dose at 8 am, the second should be at 2 pm. In some cases it can be administered in a single dose.
The most common side effects of furosemide: low potassium, low magnesium, dehydration, cramps, hypotension, increased uric acid. Rebound edema may occur after suspicion

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