Excessively vigorous diuresis may lead to intravascular dehydration before removal of edema fluid from the rest of the extracellular compartment. This is especially dangerous if the patient has significant liver or kidney disease. Once the initial correction of fluid and electrolyte derangement has been achieved, the effect sought is maintenance of homeostasis, not dehydration. Drug dosage, frequency of administration, and Na+ intake should be adjusted to achieve homeostasis.
If diuresis has been too vigorous, as may occur after injudicious use of loop diuretics, or if extensive fluid and electrolyte loss has occurred following severe diarrhea or vomiting, replacement therapy may be required. A number of available solutions resemble extracellular fluid and are useful for the repair of water and electrolyte deficits (Table 21-5).
Since the 1950s, diuretic therapy has changed dramatically. Earlier, the major diuretics were acid-forming salts, xanthines, organomercurial compounds, and carbonic anhydrase inhibitors. Either because of toxicity or lack of efficacy, these agents are rarely if ever used.
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