II. Management: Excess Sodium Intake

  1. Measure Urine Sodium excretion
  2. Increase dietary Sodium restriction if >100 meq/day

III. Management: Decreased, delayed intestinal drug absorption

  1. Bowel wall edema can reversibly impair oral absorption
  2. Switch to IV Loop Diuretic if high-dose oral fails

IV. Management: Decreased drug entry into tubular lumen

  1. Increase to maximum effective dose of a Loop Diuretic
    1. Lasix 160-200 mg IV
    2. Bumex 4-5 mg IV
  2. Special Circumstances
    1. Hepatic Cirrhosis: Spironolactone
    2. Hypoalbuminemia: Administer albumin and Loop Diuretic

V. Management: Increased distal reabsorption

  1. Multiple daily Diuretic doses if partial response
  2. Supplement Loop Diuretic
    1. Add Thiazide Diuretic or
    2. Add Potassium sparing Diuretic

VI. Management: Decreased loop Sodium delivery

  1. Mechanisms
    1. Low Glomerular Filtration Rate
    2. Enhanced proximal reabsorption
  2. Increase delivery out of proximal tubule
    1. Acetazolamide
    2. Corticosteroids
  3. Diuretic administration in supine or Trendelenburg

VII. Severe Renal Failure or secondary CHF

  1. Dialysis or hemofiltration

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