Disease state specific regimens-diuresis

• Renal insufficiency:
  • loop diuretic (↑ dose to achieve effective delivery to ThAL) ± thiazide
• CHF:
  • loop diuretic (↑ frequency over ↑ dose),
  • IV for gut edema + thiazide (watch K & Mg)
• Nephrotic syndrome:
  • urinary albumin binds secreted loop diuretic,
  • use 2-3× normal dose
• Cirrhosis:
  • spironolactone (blocks 2° hyperaldosteronism) + Lasix in 2.5:1 ratio
• Severe metabolic alkalosis:
  • acetazolamide & treat underlying cause