There are three types of diuretics: loop, potassium-sparing, and thiazide. Diuretics are also called water pills. These medications assist in the release of sodium or salt from the body. This may result in increased urine output coming from the kidneys.

Loop Diuretics

Loop diuretics are medications used to treat fluid overload characterized by edema. Conditions such as heart failure, hypertension, and nephrotic syndrome are associated with edema.

Quick Facts

• Diuretics along with loop diuretics are ACCF/AHA recommended. They are the first line of management for heart failure.
• Loop diuretic medicines are:

• • torsemide (Soaanz)
  • bumetanide (Bumex)
  • ethacrynic acid (Edecrin)
  • furosemide (Lasix)

• These can be taken with other diuretics such as thiazide in the first line of treatment.
• Loop diuretics are given intravenously for conditions such as Stage C heart failure. This stage may show signs of fluid overload such as edema.
• Loop diuretics are FDA-approved for the treatment of hypertension.
• This medication is not recommended to be given alone as the first line of treatment.
• This type of diuretic inhibits the sodium-chloride-potassium symporter, located in the limb on the Loop of Henle in the kidneys. Thus, the name “loop diuretics”.
• They are also called the high-ceiling diuretic. This means that this type of diuretic may cause diuresis far more than the other diuretics.
• It can result in a loss of fluid of about 20 pounds in a day.

Conditions

Loop diuretics are prescribed for treating:

• Pulmonary edema
• Heart failure
• Edema resulting from conditions such as heart failure, kidney and liver disease
• Hypertension

Dosage

Furosemide is a strong diuretic medication. Its action stops the reabsorption of sodium and chloride in the Loop of Henle. It also acts in the renal tubules both in the far end and the near end of the tubules. So it flushes away sodium from the body by the kidneys (natriuretic effect). This results in increased urine output.

Route

• By mouth: tablet doses available at 80, 20, and 40 mg as prescribed by the physician
• Injectables: solutions are at 10 mg/ml doses
• Half-life: almost 2 hours

Torasemide is one of the loop diuretics. Its function is to inhibit sodium chloride reabsorption. The location is at the Loop of Henle particularly in the ascending loop. Yet it doesn’t interfere with the acid-base balance, GFR, and renal plasma flow.

Route

• By mouth: tablets come in 5, 10, 20, 100 mg per doses
• Injectable: solutions are at 10 mg/mL
• Half-life: it could last almost 4 hours

Bumetanide gets rid of the unwanted sodium in the body tissues. Also, it helps get rid of too much water from the body. This is also a strong diuretic that helps in managing hypertension.

Route

• By mouth: 0.5, 1, and 2 mg per dose
• Intravenous: the solution is at .25 milligram per mL
• Half-life: almost one hour

Ethacrynic acid helps in the treatment of edema. The edema may be caused by fluid retention in the body due to conditions such as liver disease. Also, it’s used to treat some types of diabetes like diabetes insipidus.

Route

• By mouth: available dose is 25 mg
• Injection: this medication is in powder form that’s 50 mg per dose

Side Effects

• Hyponatremia
• Hypokalemia
• Hypochloremia
• Hypomagnesemia
• Metabolic alkalosis
• Prerenal azotemia
• Dehydration
• Hypertriglyceridemia
• Hypercholesterolemia
• Gout: studies have shown that diuretics could cause acute gout and flare-ups
• Restlessness
• Headache
• Dizziness
• Vertigo
• Postural hypotension
• Syncope

Careful monitoring of patients’ electrolyte levels when using diuretics is very important. Electrolyte imbalances may occur such as hypokalemia. This will affect the heart resulting in cardiac arrhythmias.

Diuretics are very strong medications that can increase urine output. If given in a higher dose, it could be fatal for the patient.

Contraindication

• Anuria
• Hypersensitivity to torsemide, furosemide, and bumetanide
• Hepatic coma
• Electrolyte depletion: this could happen in severe states
• Systemic lupus erythematosus
• Pregnancy
• Lactation

Treatment for Toxicity

• The patient is monitored through laboratory blood tests. This is to watch the potassium, chloride, and sodium levels in the body. Treatments done for patients treated with diuretics are:
  • Rehydration
  • Acid-base disturbance correction
  • Electrolyte replacement

Nursing Management

• Assess patient’s history if with known hypersensitivity to medications
• Watch skin if there is edema
• Check vital signs
• Track the input and output to ensure the fluid balance is met
• Track labs for results showing electrolyte imbalances
• Administer medications intravenously as prescribed
• Administer medicine with milk if GI upset is noted, this will buffer the effect of the medicine when taken
• Track the patient’s reaction to the medication
• Safety measures are provided, these measures such as raising side rails will prevent injuries
• Educate the patient about the therapy to encourage the patient to comply