Diuretics in Kidney Injury Paper
A 41-year-old obese male patient is diagnosed with congestive heart failure (CHF). He is told to begin a moderate exercise routine with a healthy diet and is prescribed several medications — including a diuretic. Based on your knowledge of the kidney and the disease of CHF, what factors would be important in selecting a specific diuretic? How would you explain to this patient how it works? If this patient developed a disease that caused the renal blood flow to be diminished, how might this impact the medication he is taking for his congestive heart failure? As his health care provider, how would you change his treatment in this situation?Diuretics in Kidney Injury Paper
This is a case study of 41- year-old man with congestive heart disease and is on a moderate exercise routine, healthy diet, and medicine like diuretics. Congestive heart failure (CHF) is the inability of the heart to pump blood, as it should due to the pathology of the heart muscles. This causes fluid overload in the body. Congestive heart failure presents with easy fatigability, palpitations, dizziness, and edema Hinson et al (2020). Diuretic is a group of drugs that increase the production of urine and hence reducing water volume in the body.Diuretics in Kidney Injury Paper
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Important Factors When Selecting A Specific Diuretic
The presenting symptoms will dictate the kind of diuretic that can be used. If the patient has edema, the diuretic of choice is furosemide. The dosage of the diuretics depends on the degree of edema. Before giving diuretics in a patient with CHF, a nurse is advised to check the renal function of the patient. If creatinine levels show that the patient has kidney injury, it is not advisable to give diuretics because they may worsen the kidney injury Kiracof, et al (20219). The ejection fraction determines the type of diuretic to use. Reduced ejection fraction means there is fluid overload, which needs diuretics.
Mode of Action of Diuretics
Diuretics work at the loop of Henle by reducing the absorption of sodium and water hence increasing urinary output Chen et al (2020). Diuretics also produce vasopressin hormone that inhibits the absorption of water and hence diuresis.
Impact of Diuretics in Kidney Injury
Diuretics increase diuresis hence reduces the circulating fluid volume and hence causing low renal blood perfusion and reduced glomerular filtration rate Chen, at al (2020). It also causes electrolyte imbalance through the loss of ions, calcium, sodium, and potassium. They improve fluid overload but worsen the kidney function. Diuretics in Kidney Injury Paper
How Would You Improve His Treatment In This Situation?
As suggested by Paric (2020), I would reduce the dosage of the diuretics and initiate angiotensin-converting enzyme inhibitors ACE. An example is enalapril that helps in both preload and afterload, and at the same time, it maintains the glomerular filtration rate.
References
Hinson, J. S., Ehmann, M. R., Al Jalbout, N., Ortmann, M. J., Zschoche, J., & Klein, E. Y. (2020). Risk of Acute Kidney Injury Associated With Medication Administration in the Emergency Department. The Journal of emergency medicine.
Kiracofe, B. R., Doepker, B. A., Riha, H. M., Wilkinson, R., Rozycki, E., Adkins, E., & Van Berkel, M. A. (2020). Assessment of fluid resuscitation on time to hemodynamic stability in obese patients with septic shock. Journal of Critical Care.
Parikh, C. R., & Coca, S. G. (2019). “Permissive AKI” with treatment of heart failure. Kidney international, 96(5), 1066-1068.
Wu, M. Y., Chen, T. T., Wu, M. S., & Tu, Y. K. (2020). Radio-contrast medium exposure and Dialysis risk in patients with chronic kidney disease and congestive heart failure: A case-only study. International Journal of Cardiology. Diuretics in Kidney Injury Paper