Critical Care Time
25. Diuresis & Negative Fluid Balance
Jun 3, 2024
Explore the challenges of fluid management in critical care, including mindful fluid administration, optimal medication delivery, and diuretic nephrotoxicity. Dive into the nuances of loop diuretics, choosing between purosamide and pumetinide, and optimizing drug delivery with hyper-oncotic albumin. Learn about the importance of continuous patient monitoring and engagement in critical care, with insights on alternative therapies like CRRT and oral formulations for effective patient care.
01:20:57
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Quick takeaways
- Different diuretics have unique effects and considerations for use in critically ill patients.
- Threshold doses of diuretics are important to achieve desired diuresis, especially in patients with chronic kidney disease.
Deep dives
Choosing the Right Diuretics
Loop diuretics like furosemide are commonly used in the ICU, starting at doses of 20-40 mg IV. In patients with low serum albumin, considering using bumetanide may be more effective. Thiazide diuretics, such as chlorothiazide, can cause hyponatremia and calcium imbalances. Aldosterone antagonists like spironolactone and carbonic anhydrase inhibitors like acetazolamide are also part of the diuretic arsenal.
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