Homeostatic Indications for Administration of Diuretics

Authors: M. Balík 1;  A. Kazda 2;  L. Dohnal 2
Authors‘ workplace: Klinika anesteziologie a resuscitace, Fakultní nemocnice Královské Vinohrady, přednosta doc. MUDr. J. Pachl, CSc. 2 Katedra klinické biochemie IPVZ, pracoviště Ústav klinické biochemie 1. LF UK a VFN, přednosta prof. MUDr. O. Engliš, DrSc.
Published in: Anest. intenziv. Med., , 1999, č. 4, s. 151-156


The effect of diuretics upon the natrium and water homeostasis and renal bicarbonate metabolism is seldom monitored and utilized in the intensivecare setting. The study deals in detail with the impact of diuretics upon the natrium and water homeostasis and their effects on acid-base balance. Theadministration of diuretics is enough invasive from the point of view of homeostatic monitoring with the aid of renal function tests. Therefore this studyis the integral part of the monitoring system which is based on the use of the computer programme „KIDNEY“.The authors monitored effects of furosemide (18 patients), hydrochlorothiazide (8 patients), spironolactone (14 patients), acetazolamide (10patients), amiclarane (4 patients) and manitol (8 patients) in critically ill patients using the computer programme working with 17 routinely monitoredinput values and 19 output parameters.The study attempts to clarify the exact mechanisms of the action of diuretics and to define the parameters available for monitoring and predictionof the effects of the selected agents. The broader and more correct administration of diuretics in homeostatic indications or the inclusion of some ofthe less used agents into the renoprotectione regimens could result from the study. This could be favoured by the acceptable costs of these agents.

Key words:
diuretics – intensive care – renal function tests – hypernatremia – hyponatremia – tonicity – osmolality – acidosis – alkalosis

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Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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