Summary
Observations on acute diuresis after a single high dose of a fast acting diuretic (ethaerynic acid or furosemide) are reported on in the following and some problems in diuretic therapy of chronic heart failure are discussed. The therapeutic effect of an acute diuresis in heart failure depends upon loss of volume. Blood volume (J131-albumine-method) was reduced during the first hours of acute diuresis by 1/2 to 1 liter; extravasal volume (calculated from cumulative urine volume and reduction of blood volume) was reduced at the same time by 1 to 2 liters. After 24 hours the blood volume was still reduced compared to the intial value. Simultaneous determinations of blood volume and central venous pressure indicate changes in volume extensibility of the low pressure system. Lowering venous pressure in pulmonary edema is the main objective of an acute diuresis in heart patients. Activation of sodium retention may be an unwanted reaction. Also in acute diuresis the plasma renin activity (PRA) behaved differently depending on whether the patient was in a phase of fluid loss or fluid retention. Lowering of an elevated PRA on one hand and a prolonged increase of PRA on the other has been observed. The relation of sodium- to potassium- and chloride-concentrations in the urine corresponded to the PRA. In the usual diuretic therapy of chronic heart failure, the influence on the electrolyte balance is decisive. Avoidance of electrolyte disturbances, the use of glucocorticoids supplementary to the diuretic therapy and the problem of effects of the diuretic therapy on the heart are briefly discussed.
Mit Unterstützung der Deutschen Forschungsgemeinschaft.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Literatur / References
Barger, A. C., R. D. Beblin and J. F. Tulenko: Infusion of aldosterone, 9α-fluorohydro-eortisone and antidiuretic hormone into the renal artery of normal and adrenalectomized, uúanesthetized dogs; effects on electrolyte and water excretion. Endocrinology 62, 804 (1958).
Bartter, F. C. and W. B. Schwartz: The syndrome of inappropriate secretion of antidiuretic hormone. Amer. J. Med. 42, 790 (1967).
Beyer, K. H., J. E. Baer and J. K. Michaelson: Renotropic characteristics of ethacrynic acid: a phenoxyacetic saluretic-diuretic agent. J. Pharmacol. Exper. Therapeutics 147, 1 (1965).
Boucher, R. Veyrat, J. de Champlain and J. Genest: New procedures for measurement of human plasma Angiotensin and Renin activity levels. Canad. Med. Assoc. J. 90, 194 (1964).
Brown, T. C., I. O. Davis and C.I. Johnston: Acute response in plane renin and aldosterone secretion to diuretics. Amer. J. Physiol. 211, 437 (1966).
Davidov, M., N. Kakaviatos and P. A. Finnebty: Intravenous administration of Furosemide in heart failure. J. Amer. Med. Ass. 200, 824 (1967).
Dettli, L. und P. Spbing: Pharmakologisch-klinische Prüfung neuer Diuretica. Arzneim.-Forschg. 15, 1162(1965).
Dettli, L. and P. Spring: Therapy with combination of diuretic agents: Comparative studies. Ann. N. Y. Acad. Sci. 139, 471 (1966).
Espiner, E. A., J. R. Tucci, P. I. Jagger, G. L. Pauk and D. P. Lauler: The effect of acute diuretic-induced extracellular volume depletion on aldosterone secretion in normal man Clin. Sci. 33, 125 (1967).
Espiner, E., J. Tucci, D. Lauler and P. Jagger: Absence of an aldosterone response to acute volume depletion in edematous patients. Clin. Res. 15, 201 (1967).
Fraser, R., V. H. T. James, J. J. Brown, P. Isaac, A. F. Lever and J. I. S. Robebtson: Effect of angiotensin and of furosemide on plasma Aldosterone, Corticosterone, Cortisol and Renin in man. Lancet 1965/II, 889.
Frisk, A. R., L. Werkö and G. Wrange: A new mercurial diuretic »diurgin«. Acta med. scand. 144, 85(1952).
Gauer, O. H. und J. P. Henry: Beitrag zur Homöostase des extrazellulären Kreislaufs. Volumenregulation als unabhängiger physiologischer Parameter. Klin. Wschr. 34, 356 (1956).
Gordon, R. D., O. Küchel, G. W. Liddle and D. P. Island: The effect of the sympathic nervous system on the secretion of Renin in man. J. Clin. Invest. 46, 599 (1967).
Gross, F.: Physiologie und Pathologie des Renin/Angiotensin-Systems. In: Handb. d. Inn. Med., Band 8/2, 5. Aufl., Springer-Verlag, Berlin-Heidelberg-New York 1968, S. 35–168.
Hedlund, S.: Klinische Untersuchungen mit Cedilanid. Cardiologia (Basel) 20, Suppl. 3–88 (1952).
Heidorn, G. H. and F. R. Schemm: The clinical use of corticotropin (ACTH) and adrenal corticosteroids in the therapy of intractable edema. Amer. J. med. Sci. 229, 621 (1955).
Jahemärker, H.: Die Therapie der akuten Herzinsuffizienz. Dtsch. Med. J. 18, 178 (1967).
Jahrmäbker, H.: Kombinierte Therapie mit Glykosiden und Diuretica. Therapiewoche 18, 606(1968).
Jahrmäbker, H., H. Avenhaus, H. Grohmann und Kh. R. Koozorek: Hämodynamische Auswirkungen der akuten Diurèse bei Herzinsuffizienz. Verh. Dtsch. Ges. Kreislauff. 34, 374(1968).
Jahrmäbker, H., M. v. Burnoff und G. Riecker: Über Hyponatriämiesyndrome und ihre Analyse durch Elektrolytbestimmung in Erythrozyten. Klin. Wschr. 39, 317 (1961).
Jick, H.: The use of glucocorticoids for diuresis in patients with fluid retention not resulting from renal disease. Ann. N. Y. Acad. Sci. 139, 512 (1966).
Karl, H. J.: Untersuchungen über 17-Hydroxy corticosteroide in Plasma und Urin in freier und veresterter Form bei Patienten mit hydropischer Herzinsuffizienz. Klin. Wschr. 37, 1124(1959).
Kaufmann, W. und A. A. Müller: Expansion des Plasmavolumens nach rascher Verminderung der zirkulierenden Blutmenge. Z. Kreislaufforsch. 47, 719 (1958).
Klaus, D.: Regulation der Reninsekretion. Dtsch. med. Wschr. 92, 2128 (1967).
Koczorek, Kh. R., W. Vogt, P. Schmiedeck und H. Jost: Die Auswirkungen von Störungen der Leberfunktion auf das Renin-Angiotensin-System. Dtsch. Ges. Kreislaufforsch. 33. Jahrestagg., Bad Nauheim 1967,
Koczorek, Kh. R., W. Vogt, P. Schmiedeck und H. Jost: Die Auswirkungen von Störungen der Leberfunktion auf das Renin-Angiotensin-System. Klin. Wschr. 45, 896 (1967).
Koczorek, Kh. R., B. Simon, P. Schmiedeck, W. Vogt und B. Lüderitz: Funktionsstörungen des Renin-Angiotensin-Systems bei Leberkrankheiten. V. Lebertagung d. Sozialmediziner, Bad Mergentheim, 13.–15.10.67.
Levi, G. F. et C. Proto: Effetto ipotensive del furosemide sul circolo polmonare dei mitralici. Minerva Cardioangiologica 14, 235 (1966).
Meyer, Ph., J. Ménard, J. M. Alexandre et P. Milliez: Variations de l’activité rénine plasmatique après injection d’acide éthacrynique. J. d’Urol. Nephrol. 72, 619 (1966).
Nash, H. L., E. A. Fitz, W. R. Wilson, W. M. Kirkendall and J. M. Kiosohos: Cardiorenai hemodynamic effects of ethacrynic acid. Amer. Heart J. 71, 153 (1966).
Nash, F. D., H. H. Rostorfer, M. D. Bailie, R. L. Wathen and E. G. Schneider: Relation to renal sodium load and dissociation from hemodynamic changes.
Ockenga, Th., K. Pabst und U. Stein: Zentraler Venendruck und Hämodynamik bei Herz-insuffizienten im Lagewechsel- und Aderlaßversuch. Verh. Dtsch. Ges. Kreislaufforsch. 34, 362(1968).
Pugh, L. G. C. and C. L. Wyndham: The circulatory effects of mercurial diuretics in congestive heart failure. Clin. Sci. 8, 10 (1949).
Rosenthal, J., R. Boucher, W. Nowaczynski and J. Genest: Acute changes in plasma volume, renin activity, and free aldosterone levels in healthy subjects following Furosemide administration. Canad. J. Physiol. Pharmacol. 46, 85 (1968).
Samet, P. and W. H. Bernstein: Acute effects of oral ethacrynic acid upon total blood volume. Amer. Heart J. 75, 288 (1968).
Schneideb, K. W.: Hämodynamische Wirkung von Diuretika. Münch. Med. Wschr. 51, 2571 (1966).
Schwiegk, H. und H. Jahrmärker: Therapie der Herzinsuffizienz. In: Handb. Inn. Med., 4. Aufl., Bd. 9/1, S.402ff., Springer-Verlag, Berlin-Göttingen-Heidelberg, 1960.
Seldust, D. W. (consulting editor): The physiology of diuretic agents. Ann. N. Y. Acad. Sci. 139, 273–539(1966).
Truniger, B. und W. Slegenthaler: Aldosteron und Diuretica. Klin. Wschr. 38, 133 (1963).
Wolff, H. P.: Das Renin-Aldosteron-System bei hydropischen Erkrankungen. 74.Tagg. dtsch. Ges. Inn. Med., Wiesbaden 1968.
Wolff, H. P., L. Bette, H. Blaise, G. Düstebdiece:, J. Jahnecke, T. Kobayashi, F. Krück, D. Lommer and H. Schteffeb: Kole of aldosterone in edema formation. Ann. N. Y. Acad. Sci. 139, 285 (1966).
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1969 Springer-Verlag Berlin · Heidelberg
About this chapter
Cite this chapter
Jahrmärker, H., Koczorek, K.R., Avenhaus, H., Grohmann, H. (1969). Clinical Application of Diuretics in Cardiac Diseases. In: Thurau, K., Jahrmärker, H. (eds) Renal Transport and Diuretics / Renaler Transport und Diuretica. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-88089-6_41
Download citation
DOI: https://doi.org/10.1007/978-3-642-88089-6_41
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-88091-9
Online ISBN: 978-3-642-88089-6
eBook Packages: Springer Book Archive