|Acute Heart Failure
|Chronic Heart Failure
Loop Diuretics |
Entresto Sacubitril with Valsartan |
Angiotensin Converting Enzyme Inhibitors |
Cardiac Resynchronisation Therapy (CRT) Pacemaker |
Diuretics should not be used on a long-term basis to treat simple gravitational oedema. This will usually respond to increased ambulation, raising the legs and support stockings.
- Loop diuretics: See BNF or equivalent for UpToDate prescribing advice
- These are potent diuretics useful for the rapid excretion of Salt, other electrolytes and water. Often used in the acute treatment of Left ventricular failure.
- 3-(butylamino)-4-phenoxy-5-sulfamoylbenzoic acid.
- Heavily bound to albumin.
Mode of action
- Block primarily the absorption of sodium and chloride not only in the proximal and distal tubules but also in the loop of Henle.
- Effect depends on renal clearance so may be diminished in older patients
- Acute LVF: Bumetamide 1-2 mg given as a single iv dose
- Congestive cardiac failure: Bumetanide 1 mg OD to 2 mg BD
- Hypertension: Bumetanide 1 mg OD often with an ACEI or ARB. Not recommended as a single agent
- Fluid overload - Liver failure: Bumetanide 1 mg OD
- Nephrotic syndrome: Bumetanide 1 mg OD
- Treat hypercalcaemia, Treat hyperkalaemia: rarely used but IV dose may be given
Dose range:You must check with BNF or drug datasheet
|Bumetanide (Heart failure)||1-2 mg ||OD||PO|
- Avoid with ototoxic drugs
- Monitor renal function and electrolytes
- Hypokalaemia can increase Digoxin toxicity
- Elderly patients are particularly susceptible to the side-effects of diuretics.
- Volume depletion and orthostatic hypotension and falls especially in elderly
- Hypokalaemia and metabolic alkalosis, Hypomagnesaemia
- Hypocalcaemia and Hypercalciuria and calcium excretion
- Hyperuricaemia (can lead to gout)
- Ototoxicity - tinnitus especially avoid with aminoglycosides
- Diabetes and Hyperglycaemia
- Digoxin toxicity as causes hypokalaemia
- Can cause lithium toxicity through its actions on renal clearance