II. Management: Excess Sodium Intake
- Measure Urine Sodium excretion
- Increase Dietary Sodium restriction if >100 meq/day
III. Management: Decreased, delayed intestinal drug absorption
- Bowel wall edema can reversibly impair oral absorption
- Switch to IV Loop Diuretic if high-dose oral fails
IV. Management: Decreased drug entry into tubular lumen
- Increase to maximum effective dose of a Loop Diuretic
- Special Circumstances
- Hepatic Cirrhosis: Spironolactone
- Hypoalbuminemia: Administer albumin and Loop Diuretic
V. Management: Increased distal reabsorption
- Multiple daily Diuretic doses if partial response
- Supplement Loop Diuretic
- Add Thiazide Diuretic or
- Add Potassium sparing Diuretic
VI. Management: Decreased loop Sodium delivery
- Mechanisms
- Low Glomerular Filtration Rate
- Enhanced proximal reabsorption
- Increase delivery out of proximal tubule
- Diuretic administration in supine or Trendelenburg
VII. Severe Renal Failure or secondary CHF
- Dialysis or hemofiltration