Core IM | Internal Medicine Podcast
#158 Diuretics Resistance Cases
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.
28:40
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Quick takeaways
- Addressing underlying flow issues before adjusting diuretic doses is crucial to optimize renal function and diuresis.
- Enhancing cardiac contractility through interventions like inotropic support can significantly improve diuretic responsiveness in heart failure patients.
Deep dives
Understanding Cardio-Aureanal Syndrome
The management of Cardio-Aureanal Syndrome primarily revolves around improving renal blood flow before addressing diuretic treatments. Cases discussed illustrate that without resolving underlying flow issues, increasing diuretic doses may not yield the desired diuresis. For example, one case highlighted a patient with elevated intra-abdominal pressure which significantly impaired renal blood flow, resulting in acute kidney injury. After relieving the pressure through a paracentesis, the patient experienced a dramatic increase in urine output and improvement in kidney function, showcasing the critical need to address flow to optimize diuretic effectiveness.
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