Diuretics

nephron
the functional unit of the kidney
capable of forming urine
has two major components:
glomerulus
tubule:
proximal
loop of Henle
distal
collecting


Formation of Dilute Urine
Figure 15.10
Spironolactone
Specific pharmacologic antagonist of aldosterone
Competitive binding of receptors at the aldosterone-
dependent sodium-potassium exchange site in the
distal convoluted renal tubule.
Causes increased amounts of sodium and water to
be excreted, while potassium is retained.
Acts both as diuretic and as antihypertensive by this
mechanism.
Given alone or with other diuretic agents which act
more proximally in the renal tubule such as
Frusemide in loop.

Spironolactone.

0-10 kg 6.25 mg
11-20 kg 12.5 mg and so on [not mg/kg]
Hyperkalemia!
Congestive heart failure: Management of
edema and sodium retention.
Concomitant administration of ACE inhibitors
with potassium-sparing diuretics has been
associated with severe hyperkalemia.

Hyperkalemia warning signs:
Parathesia
Muscle weakness
Fatigue
Flaccid paralysis of the extremities
Bradycardia
Shock
ECG changes

Frusemide
Cheap
Powerful.
0.5-1 mg/kg bolus
By infusion gives better diuresis than
bolus.
Tinnitus, hypokalemia, hyponatraemia.
0.1-1 mg/kg/hr through steps. In
adults1,000 mg/day has been given.