DIURETICS

DEFINITION WHAT ARE DIURETICS

Medications that produce increased urine flow

by inhibiting sodium and water reabsorption.
2 Main Purposes:
decrease hypertension and decrease edema

Every 1.5 Hours total ECF in the body is filtered

in the kidneys (glomeruli) electrolytes, glucose,
drugs and waste products from protein
metabolism are filtered
Protein and Blood Cells (RBC, WBC, Platelets) are
not filtered.
DEFINITION WHAT ARE DIURETICS

99% of the filtered sodium that passes through

the glomeruli is reabsorbed:
50 55% is reabsorbed in the proximal tubules
35% - 40% in the Lop of Henle
5% - 10% in the distal tubules
Less than 3% in the collecting tubules

Diuretics that act closest to the glomeruli

have the greatest effect for natriuresis
(sodium loss in urine)
TYPES OF DIURETICS

Many diuretics cause the excretion of

electrolytes potassium, magnesium,
chloride and bicarbonate

2 General Types of Diuretics

1. Potassium Wasting
2. Potassium Sparing
POTASSIUM WASTING THIAZIDE
DIURETICS

Blocks the chloride pump in the ascending

limb of the Loop of Henle and the distal
tubule sodium moves with chloride

Blocking the chloride pump keeps the

chloride and sodium in the tubule to be
excreted
Little volume of urine is produced but it is
rich in sodium saluretic effect
POTASSIUM WASTING THIAZIDE
DIURETICS

Hydrochlorothiazide (HydroDiuril),
Chlorothiazide (Diuril

Indications Peripheral Edema in CHF,

Hypertension
Contraindications Fluid and Electrolyte
Imbalances, Renal and Liver Disease normal
renal function is required, Diabetes Mellitus
Adverse Effects Hypokalemia (muscle cramps,
weakness, arrhythmias) Hypercalcemia (due to
calcium reabsorption) Hyperglycemia
POTASSIUM WASTING LOOP
DIURETICS

Blocks the chloride pump in the ascending

Loop of Henle decreasing reabsorption of
chloride and sodium
Exert a similar effect in the descending
Loop of Henle and the distal tubule
resulting in copious amounts of sodium
rich urine
More potent than Thiazide Diuretics
increases renal blood flow by 40% which
leads to production of more urine
POTASSIUM WASTING LOOP
DIURETICS
Furosemide (Lasix)

Indications Acute CHF, Pulmonary

Edema in CHF, Hypertension, End Stage
Renal Disease
Contraindications Electrolyte Depletion,
Anuria, Hepatic Coma, Pregnancy and
Lactation
Adverse Effects Hypokalemia,
Hyponatremia, Hypocalcemia, Hypotension
POTASSIUM WASTING OSMOTIC
DIURETICS

Uses a sugar compound that is not well

reabsorbed by the tubules
Acts to pull large amounts of fluid into the
urine by the osmotic pull of the large
sugar molecules
Large amounts of fluid are lost in the urine

Administered only through IV Infusion

POTASSIUM WASTING OSMOTIC
DIURETICS

Mannitol (Osmitrol)

Indications Emergency situations

where there is increased IOP (glaucoma)
and ICP (intracranial bleeding), Ascites,
Oliguria
Contraindications Renal Disease,
Pulmonary Congestion, Dehydration, CHF
Adverse Effects Hypotension,
Confusion and Headache, Shock
POTASSIUM SPARING DIURETICS

Blocks the action of aldosterone in the

distal tubule
Aldosterone a mineralocorticoid
hormone that promotes sodium retention
and potassium excretion.
Interfere with the sodium potassium
pump thereby excreting sodium and
conserving potassium
Weaker than Loop and Thiazide Diuretics
POTASSIUM SPARING DIURETICS

Spironolactone (Aldactone)

Indications Hypertension,
Hyperaldosteronism, Patients taking
antiarrythmics or digoxin who are at risk for
hypokalemia
Contraindications Renal Diseases,
Hyperkalemia, Anuria
Adverse Effects Hyperkalemia, Lethargy,
Confusion, Muscle Cramps, Cardiac
Arrythmias
GENERAL NURSING CONSIDERATONS

1. Administer oral drug with food or milk.

Administer early in the day and do NOT
administer before sleeping.
2. Administer IV infusion slowly or through
an infusion pump.
3. Monitor urine output and weigh patient
daily.
4. Monitor vital signs as appropriate
focusing on heart rate
GENERAL NURSING CONSIDERATONS

5. Monitor periodically or as ordered heart

rhythm through ECG or cardiac monitor.
6. Protect oral drugs from light and discard
diluted drug after 24 hours.
7. Provide potassium rich (K wasting) or
potassium poor (K sparing) diet as
appropriate.
8. Provide general care according to
condition of the patient (diagnosis
based care)