Use, misuse and abuse of diuretics

Published: 21 February 2017
Author(s): Ettore Bartoli, Luca Rossi, Daniele Sola, Luigi Castello, Pier Paolo Sainaghi, Carlo Smirne
Section: Narrative Review

Resolution of edema requires a correct interpretation of body fluids-related renal function, to excrete the excess volume while restoring systemic hemodynamics and avoiding renal failure. In heart failure, the intensive diuresis should be matched by continuous fluids refeeding from interstitium to plasma, avoiding central volume depletion. The slowly reabsorbed ascites cannot refeed this contracted volume in cirrhosis: the ensuing activation of intrathoracic receptors, attended by increased adrenergic and Renin release, causes more avid sodium retention, producing a positive fluid and Na balance in the face of continuous treatment.