Core IM | Internal Medicine Podcast #158 Diuretics Resistance Cases
26 snips
Aug 28, 2024 Explore the intricacies of diuretic resistance with three compelling cardiorenal case studies. Discover how intra-abdominal hypertension and low cardiac output challenge effective diuretic use. Learn the importance of renal perfusion and hemodynamic assessments in managing fluid issues, particularly in critically ill patients. Uncover key interventions and decision-making strategies that can improve patient outcomes in complex scenarios involving heart and kidney complications.
AI Snips
Chapters
Transcript
Episode notes
Intra-Abdominal Hypertension and Flow
- Intra-abdominal hypertension can severely reduce renal blood flow and cause diuretic resistance.
- Paracentesis to relieve pressure restores urine output and kidney function dramatically.
Use Hemodynamics to Guide Therapy
- For diuretic resistance with low cardiac output, assessing hemodynamics with right heart catheterization guides management.
- Inotropic support like dobutamine can improve cardiac output, urine output, and organ function.
Renal Perfusion Pressure Matters
- Normal blood pressure doesn't guarantee adequate renal perfusion in heart failure.
- Renal perfusion pressure, calculated as MAP minus CVP, better reflects kidney blood flow needs in these patients.