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Approach to Diuresis
Nov 6, 2023
Dr. Leslie Chang and Dr. Joyce Zhou discuss determining volume status, guidelines for inpatient diuretic treatment, side effects of diuretics, and a case update on achieving effective diuresis.
27:01
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Quick takeaways
- Determining a patient's volume status involves considering historical features, physical exam findings, and lab values as indicators of volume overload.
- Initiating inpatient diuresis with IV furosemide at an increased dose is recommended over the oral form, and adjusting the dose based on urine output is crucial for desired diuresis.
Deep dives
Determining Volume Overload
To determine if a patient is volume overloaded, historical features, physical exam findings, and lab values are considered. Symptoms like orthopnea and paroxysmal nocturnal dyspnea, along with worsening lower extremity swelling and abdominal distension, can indicate volume overload. Physical exams, especially assessing jugular venous pressure (JVP), are crucial in diagnosing decompensated heart failure. Lab values like serum creatinine and NT-proBNP are also taken into account for a comprehensive evaluation of volume status.
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