Clinical Application of Diuretics During and After Heart Surgery
Operations on the heart with the help of the heart-lung machine create overloads of sodium and water which must be corrected postoperatively by renal activity. The minimal urine flow rate for this purpose should amount to 1.0 ml/min.
Urine secretion was supported in 8 patients who had had atrial septal defects repaired with the aid of the heart-lung machine by spontaneous osmotic diuresis (2) or by administration of mannitol (2) or ethacrynic acid (1) or furosemide (3). Peak osmotic flows amounted to 11–13 ml/min; after furosemide 28 ml/min; and after ethacrynic acid 115 ml/min. It was concluded from measurements of sodium, osmolality and creatinine that during the ethacrynic acid-induced diuresis no reabsorption of fluid occurred beyond the proximal tubule.
Furosemide proved to be the most useful diuretic after extracorporeal circulation, since it produced excretion of sodium and water more effectively as compared with mannitol, and a more moderate diuresis as compared with ethacrynic acid. High postoperative potassium loss in the urine occurs with any of these compounds.
Indications for administration of effective diuretics (oral single doses of ethacrynic acid or furosemide) during the remainder of the postoperative course were diminution of the urine flow rate and evidence of congestion of the greater or lesser circulation. Ethacrynic acid proved superior in terms of increased urine volume, diminution of body weight, and reabsorption of pleural effusions. Both compounds counteracted postoperative aldosteronism since the urinary sodium-potassium ratio rose from control values of unity after administration of diuretics to more than 3. Circulatory complications or manifestations of intolerance were not observed.
KeywordsAtrial Septal Defect Urine Flow Rate Ethacrynic Acid Increase Urine Volume Urine Secretion
Klinische Anwendung von Diuretica während und nach Herzoperationen
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Literatur / References
- 2.Seldin, D. W., Gr. Eknoyan, W. N. Suki and F. C. Rector: Localisation of diuretic action from the pattern of water and electrolyte excretion. In: The pharmacology of diuretic agents. Ann. New York Acad. Sci. 139, 328 (1966).Google Scholar