This material is dedicated to the treatment of edema, both general and local ones. Edema is a complex problem of modern medicine, especially in the diagnostic section, in primary care health care. It can be long and complex, take away a lot of time of the doctor and the patient’s strength, and often – and his means. No wonder the chapter on peripheral edema inevitably comes in a reprint of the reference book of R. B. Taylor, popular among doctors “Difficult diagnosis.”
Therefore, this material can help patients think through. the right answers at the doctor’s appointment and learn about using which drugs can eliminate puffiness. Naturally, self-medication is strictly prohibited, and drug information preparations in this article are for reference only. Only a doctor should prescribe drugs. But first you need to be sure determine what is edema.
- What is swelling, and what are they
- General, or generalized edema
- A heart
- Protein drop in blood
- Local or local edema
- Lymph drainage
- Varicose veins and leg vein insufficiency
- Nervous reason
- No reason?
- Healed !!!
- The most dangerous swelling
- Pharmacotherapy of edema
- The best cure for edema
- Diuretics, they are diuretics
- Osmotic diuretics
- Mannitol (Mannitol)
- Advantages and disadvantages
- Acetazolamide (Diacarb)
- Advantages and disadvantages
- Thiazide diuretic
- Hydrochlorothiazide (hypothiazide)
- Advantages and disadvantages
- Loop diuretics
- Advantages and disadvantages
- Potassium-sparing diuretics
- Spironolactone (Veroshpiron, Vero-Spironolactone, Veroshpilacton, Aldacton)
- Advantages and disadvantages
What is swelling, and what are they
Edema, along with various types of rash, jaundice, pallor, almost always, at all times, they were considered indicators of the disease. Old doctors said that heart swelling occurs on the legs, and the kidneys are on the face, and this is true. Edema called an increase in the size of any part of the body, due to excessive accumulation of fluid inside the tissues. Total swelling so and is called – puffiness, since there is no exact localization here. Doctors subdivide all possible fluid retention into generalized and local edema.
The causes of edema may vary. This is a sudden increase capillary permeability, violation of the outflow of venous blood, as with varicose veins, lymphatic edema, decreased plasma protein. It is known that hungry people “swell with hunger”, that is, swell. This symptom occurs with low plasma oncotic pressure, which supports albumin. Therefore they are also called protein-free edema.
General, or generalized edema
The most dangerous in the long-term prognosis are general edema, or generalized. If they arose, then it is almost always says a serious disruption in the body. In the appearance of common edema is to blame either the heart, or the kidneys, or a critical decrease plasma protein. Here are some common ones situations:
Cardiac or cardiogenic edema occurs when insufficient work of the heart ventricles. They just can’t develop such strength and frequency of contractions that in a timely manner pump the entire volume of fluid. Therefore, the main and most frequent the diagnosis is heart failure, which is why they call it stagnant (stagnation of excess fluid).
Where does stagnation occur? In the pulmonary circulation, that is, in lungs, and this can lead to their edema, which is called cardiac asthma. Heart failure is manifested by edema and a large circle of blood circulation. Most often, they begin to swell first ankles, then lower legs, then – symmetrical edema rises to knee level, and goes higher. The stomach gradually accumulates free fluid, ascites develops. In the abdomen and lower back subcutaneous fat begins to swell, due to edema enlarged liver. Naturally, all this is accompanied by symptoms of dyspnea increasing during physical exertion, which then begins to bother and at rest, and a sharp decline exercise tolerance.
Edema with kidney pathology most often occurs in violation cortical layer, where structural and functional units kidneys – nephrons that produce urine. Of course to the kidney long-term urinary diseases can also lead to edema systems, for example, chronic pyelonephritis, but only if if the outcome is hydronephrosis and wrinkling of the kidneys. But most often in edema is responsible for nephritis and nephrosis, inflammation of the renal cortex, or glomerulonephritis.
A large percentage of patients with renal edema are individuals suffering from the so-called systemic collagenoses. it rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma and other diseases. The cause of common edema there may be both chronic and acute renal failure. The difference is that in acute renal failure, acute failure, they occur much faster. Unlike cardiac edema, renal appear not on the legs in the debut of their development, but on the upper half of the body. Classical localization is eyelids, face, and symmetrically swelling hands. Renal edema occurs in the morning, and in the evening they are decreasing.
Protein drop in blood
Finally, edema due to a fall in protein in the blood plasma with cachexia, alimentary protein deficiency, multiple organ failure and appear with various severe systemic diseases. The cause may be nephrotic syndrome and prolonged starvation, advanced stages of malignant neoplasms with distant metastases, and other pathological processes.
There is such a proteinless, or cachectic edema in in case total protein falls below 60 g per liter, with lower the concentration limit is 65 g / l, and the concentration of albumin is reduced less than 35 g / l. Such edema usually begins on the legs, then pass to the arms and torso. Unlike heart edema, which are dense, or inductive, such hungry edema reminiscent of a soft pillow, the skin above them is thinning and becomes pale.
Local or local edema
If it was mentioned above about the role of organ systems (cardiovascular, excretory) then in the case of local edema, the level of damage is lower, we are talking about individual pathological processes. Organ systems tend to work fine, and chronic or acute them failure is not detected. What are these pathological processes? There are quite a lot of them, even it is estimated that edema of the extremities are the fifth most common complaint when you see a doctor.
Complaints about local edema are quite understandable, they are clearly visible, immediately regarded by the patient as an undoubted sign of the disease, and their asymmetry is especially worrying. Most worried edema of women, especially from a cosmetic point of view. Therefore edema this is that small group of visible symptoms and signs when sick immediately go to the doctor, which cannot be said, for example, about toothache and other conditions.
Inflammation is well known to everyone. The banal boil is classic inflammation that contains all five signs known since antiquity. This is redness, feeling heat, pain, impaired function and edema. With inflammation, swelling occurs, firstly, as a result of tissue damage, and development hyperemia, that is, blood flow to the site of inflammation. Arises venous congestion, hyperemia in the veins, and blood pressure in the vessels begins to exceed the pressure in the tissues that these vessels surround. Therefore, not blood from the tissues goes into the vessels, but vice versa.
Thus, edema with inflammation lasts several days with acute process or longer in chronic, and then it resolves. Where there is inflammation, there will be edema, and it manifests itself increased local skin temperature and hyperemia, i.e. redness. A classic example of such inflammatory edema there may be acute arthritis with damage, for example, knee or elbow joint, phlegmon, or diffuse purulent inflammation subcutaneous tissue, and other diseases. It should be recalled that all signs of inflammation are clearly expressed only with normal immunity. In patients with HIV infection, or those taking immunosuppressants, cytostatics or hormones, inflammatory the symptomatology is expressed erased.
Lymphostasis, or impaired lymph flow in our time, and in of our country most often occurs with malignant neoplasms and metastases in the lymph nodes, since these formations compress the lymphatic vessels both from the inside and outside. But in hot countries, most often elephantiasis, or elephantiasis, arises as a result of parasitic invasion by special worms – filarias when they settle in the lymph nodes and disrupt outflow of lymph.
Any lymphatic edema is localized very clearly, have good severity. Almost always they are painless, over thick skin. In some cases, such edema may occur. after surgery if the patient has been removed regional lymph nodes, which happens almost exclusively with malignant neoplasms. In this case, the patient may be one-sided, fairly massive and persistent lymphatic edema.
Varicose veins and leg vein insufficiency
After general edema, leg edema with varicose veins rank second in the general classification of excess fluid in body frequency of occurrence. Their cause is a violation the activity of a kind of pump of veins, their valves and muscles, which normally should pump blood up against gravity, into the inferior vena cava. If the venous valves stop normal work and collapse, then blood stagnates in these veins, again, pressure rises in them, they begin to expand, wriggle, nodes form, and blood goes back into the tissues, not having managed to rise into large vessels. This leads to chronic venous insufficiency of the lower extremities. Besides varicose veins, the cause of venous edema in the legs post-thrombotic disease, venous trauma, and so on. Classic varicose veins is swelling of the legs and feet in the evening, feeling fullness and fatigue in the legs, and especially after prolonged staying standing all day on his feet. Therefore, varicose veins are professional pathology of surgeons, turners, and representatives other “standing” professions. Then join the vascular asterisks, varicose dermatitis, and finally trophic ulcers.
Swelling can occur due to “nerves”, but not because of stress or hysteria, but due to an abnormality of the autonomic vascular tonus. It is known that the nerves of the autonomic system surround the vessels, and regulate vasoconstriction, i.e. vasoconstriction and vasodilation, that is, their expansion. If the contraction of blood vessels will be weakened, and they will almost always be dilated, then the vascular permeability will increase and arterial blood from the capillaries will begin flow heavily into the tissue. Such a nervous cause leads to the occurrence of angiotrophoneurosis, and appears with such diseases like paralysis of a central neuron (central paralysis). In such patients, a peripheral neuron lying in the front horns of the spinal cord, disinhibitions, and gets some autonomy without brake pulses from above. Arise nerve edema with syringomyelia, with trigeminal neuralgia and another pathology.
Allergic edema is known to everyone. It’s fast onset condition, with swelling of the face, eyelids, tongue, lips, neck. Swell those places influenced by large amounts of histamine where there is good blood supply, and loose subcutaneous tissue. Therefore expansion blood vessels, a change in the permeability of the wall, leads to a significant increase in fluid volume and the appearance of a specific allergic symptoms
So, with Quincke’s edema, intense lacrimation may occur, itching in nose and eyes, sneezing, profuse watery discharge from nose, or rhinorrhea. Allergic edema is also quite common. arise on the limbs, in places of contact with a pronounced allergen, or hives.
Yes, it happens. More precisely, there is no reason established so far. AND then such an edema is called idiopathic, that is, arising without reasons. Most often, young women suffer, or a little older, but of childbearing age. Edema occurs in the summer, during the hot season, and especially on the shins. The second localization is fingers, eyelids. Edema usually increases by the end of the day and maximum intensity reach in the evening. Usually, such swelling is characteristic of overweight women and various vegetative reactions like frequent hot flashes. But still the appearance of such idiopathic edema is associated with stress, possibly long the use of diuretics, as well as during pregnancy.
It’s about drug edema. If the patient is prescribed high doses of corticosteroid hormones if it takes beta-blockers to lower blood pressure or calcium blockers, then it develops, though not always, local edema. Most often these are feet and legs, face and forearms. In some cases, together with edema can be detected redness of the skin, or hyperemia. The second kind of iatrogenic edema caused by medical intervention is the consequences of removing regional lymph nodes like palliative surgery for malignant neoplasms.
The most dangerous swelling
Of all the types of edema described, there are two of the most dangerous, which can be fatal. The first is edema brain. It is treated the worst and mortality in this form edema is the largest. Usually the cause of cerebral edema is a severe hemorrhagic stroke, subarachnoid hemorrhage with severe prolonged vasospasm. It’s heavy traumatic brain injuries, the presence of volumetric formation in the cavity skulls.
Rapid increase in intracranial pressure leads to soft swelling tissue, and exit the pressure from the closed bone ball-skull nowhere to go. Therefore, various types of wedging arise, of which one of the most dangerous is the insertion of the cerebellar tonsils into a large occipital foramen. All structures lying in the posterior cranial fossa, experience severe compression, and death occurs from cardiac arrest and breathing, as the most nearby an ancient and vital part of the brain is the trunk and medulla. They are infringed in the large occipital holes, it is in these structures that is located vasomotor and respiratory center that regulates respiration and blood circulation.
The second type of edema, which is also dangerous, but which can be successfully stopping even on an outpatient basis is cardiac asthma, or pulmonary edema. In the left atrium, pressure rises as the left ventricle is not able to ensure the transfer of blood to the aorta, and pressure builds up in the pulmonary circulation, that is, in the lungs. Then the blood flows under the influence of pressure in the lung tissue and begins a massive cough, and choking. Patient begins to expectorate a large amount of pink and foamy sputum. Treatment boils down to a sharp decrease in venous return of blood to the heart. And here they can help hot baths for arms and legs, tourniquets on limbs. The patient is injected with drugs that improve heart function, nitroglycerin, diuretics give oxygen.
Pharmacotherapy of edema
We saw that there are many causes leading to edema. can not be said about drugs that are used for this pathology. There are only two main groups of drugs. are diuretics, or diuretics, as well as class drugs venotonic, that is, affecting the metabolism of the venous wall. Little diuretics are known, and much more venotonics, since their composition includes plant components. Today we consider in a medical review a group of diuretics.
Diuretics can be used both with local and general edema, and drugs that improve venous outflow – only with edema on the extremities, and if their cause is varicose varicose veins, or chronic venous insufficiency. IN In this review, we will not consider remedies for treatment allergic and inflammatory edema. There are already articles on allergy medications, modern arthritis remedies, NSAID drugs.
In our review of diuretics, we consider only the most relevant and effective drugs registered in the territory Russian Federation. Each drug is first given an international non-proprietary name, or INN, and then the name the original drug that first entered the market, if any, as well as synonyms for various commercial copies. Also a price range will be given at which you can purchase this drug in all pharmacies of the Russian Federation. Price relevant for the fall of 2019.
The best cure for edema
|Nomination||a place||Name of product||price|
|Osmotic diuretics||1||Mannitol (Mannitol)||97 rub|
|2||Acetazolamide (Diacarb)||267 rub|
|3||Thiazide diuretic||441 rub|
|4||Hydrochlorothiazide (hypothiazide)||75 rub|
|Loop diuretics||1||Furosemide||16 rub|
|Diuretics, preserving potassium||1||SPYRONOLACTONE (VEROSHPIRON, VERO-SPIRONOLAKTON, VEROSHPILAKTON, ALDACTON)||167 rub|
Diuretics, they are diuretics
Diuretics are universal salvation for local and general edema. But, since they act systemically, the main goal is decrease in total excess fluid in the body. At the beginning of treatment Be sure to follow the rules of forced diuresis. it means that the patient must monitor the amount consumed by him liquids. In this case, the volume of urine excreted should be greater than total fluid intake, at least 200-300 ml per day. At it is necessary to maintain a stable body weight, and not to allow drinking large amounts of water. Therefore start treatment diuretics are needed with small doses, and as needed a doctor increases this dosage. As soon as the edema is eliminated, or their the volume is significantly reduced, the dose of the diuretic is either reduced, or they canceled altogether. What are diuretics?
These are diuretics that work exclusively on the physical osmosis effect. Osmosis is the process of penetration of liquid molecules towards a higher concentration, in the presence of separating them semipermeable membrane. These drugs are loved by anesthetists and resuscitators, they are well filtered by the kidneys, are not absorbed inside, improve the osmolarity of blood plasma, and can affect state of electrolyte balance. In total, two such the drug. Mannitol, or Mannitol, is used only intravenously, and almost always used in a hospital, for example, in a department neurosurgery. Doctors like to prescribe the second drug on an outpatient basis, to reduce intracranial pressure, and this is common knowledge Diacarb. Let’s consider their effects separately.
Popularity Rating: 4.9
The magnet is used only in severe conditions. It’s edema brain, glaucoma, acute renal failure and epileptic status, barbiturate poisoning, that is, all those conditions that lead to a rapid increase in intracranial pressure. Therefore mannitol can be considered a means of salvation from death, without any exaggerations. It is administered only intravenously, and in order to eliminate the general increase in the amount of fluid, it is used together with loop diuretics, for example, with furosemide.
Since treatment is carried out under the strict control of hemodynamics and water-electrolyte balance, then Mannitol is used, in mainly in intensive care. Before use, the medicine is heated in a water bath to body temperature, especially if it is introduced a lot. There is one pack of Mannitol (400 bottle ml) about 100 rubles, but no one buys it in pharmacies, because in he always has hospitals, but he is not appointed as an outpatient. Both Mannitol and Mannitol are domestic drugs production.
Advantages and disadvantages
Despite the fact that this is salvation from death, it is contraindicated with hemorrhagic stroke and subarachnoid hemorrhage, with severe forms of dehydration, with a sharp drop in blood concentrations of potassium and sodium along with chlorine in acute tubular necrosis. Mannitol can also cause side effects. It cramps and dry mouth, thirst and pressure drop, tachycardia and even hallucinations. That is why the medicine is used only in in a hospital, in extreme cases, patients with glaucoma can to drip in the “day” hospital, but also under the supervision of a doctor.
Popularity Rating: 4.8
This medicine acts on a single enzyme, carbonic anhydrase in the kidneys. As a result, the opposite is reduced. absorption in the blood of bicarbonate, sodium and potassium. The medicine boosts urine pH, that is, reduces its acidity, increases urine output, and leads to a decrease in intracranial and intraocular pressure. Diacarb has anticonvulsant activity. Therefore it the drug is taken not only for edema, but also for glaucoma, epilepsy, and intracranial hypertension syndrome. With edema the drug is prescribed once every other day, with a one-day break. For Diakarb, the phenomenon of the “limiting” dose is interesting. a further increase in dose does not enhance the diuretic effect. Diacarb available in 250 mg tablets, and a pack of 30 tablets domestic company Akrikhin will cost from 220 to 300 rubles.
Advantages and disadvantages
In neurologists, Diacarb is considered a panacea for any suspicion of increased intracranial pressure, on a spilled headache, on pressing pain in the eyes. But at the same time, its side effects should be considered. effects. Quite often, while taking Diakarba, the appetite falls, taste disturbance occurs, dizziness appears, develops feeling tired. The number of common side effects is very large, but fortunately, many of them are rare. So, to rare “side effects” include aplastic anemia, transient myopia, photosensitization.
A lot of contraindications should be taken into account. It is hepatic insufficiency with the risk of developing encephalopathy, blood acidification or metabolic acidosis, pregnancy, lactation and children under 3 years old, low concentration of corticosteroid hormones, or hypocorticism, as well as Addison’s disease. In patients with diabetes mellitus diacarb should be used with great care, as they increased risk of hyperglycemia. With long-term administration of diacarb drowsiness may occur, therefore drive and work with dangerous mechanisms while taking the drug is undesirable.
Popularity Rating: 4.7
Thanks to these diuretics, without exaggeration, it increased life expectancy for so many many hundreds of thousands and millions of older people because such a drug, how hydrochlorothiazide and indapamide come in many combination antihypertensive drugs in which the active substance, for example angiotensin receptor blocker enhanced diuretic. (Lorista N, Gizaar, Vazotens, Lozapus plus).
They have a diuretic effect, excrete from the body. sodium, and act at the level of the tubules of the nephron. They boost excretion of potassium and magnesium in the urine, but reduce the output from the body calcium and uric acid. They are used as a diuretic in cardiac edema, and especially with edema in patients with hypertension, but not as an ambulance, but for routine therapy.
They are not recommended for patients with impaired function. kidneys, since against its background they can provoke interstitial nephritis and cause, or aggravate, renal failure. Insofar as Since all these funds remove potassium, they are not recommended to be taken with a low concentration of potassium in the blood, or hypokalemia, and with gout. However, if they are used in small dosages, as an addition to antihypertensive drugs, then the risk of reception is much lower.
Popularity Rating: 4.6
In general, all diuretics are inexpensive drugs, and hypothiazide is a typical medicine in this regard. Hypothiazide can purchase at prices from 47 to 120 rubles. per pack, 100 tablets mg, No. 20. Hypothiazide is produced by the Hungarian company Hinoin, and he considered a medium strength diuretic. It is stronger than potassium-sparing Veroshpiron diuretic, and weaker than loop diuretics, for example Furosemide. We will discuss them further.
The merit of hypothiazide can be considered the lack of influence on acid-base state of the body. It also removes magnesium, but retains calcium and uric acid salts in the body. Diuretic the effect begins in an hour and a half, reaches its peak in 4 hours, and after 10-12 hours it decreases. The drug is able to gently lower blood pressure due to volume reduction circulating fluid in the body, and it also reduces the effectiveness vasoconstrictors, such as nasal drops containing alpha adrenomimetics.
It is indicated for use, primarily in arterial hypertension, with edema, and widespread, with portal hypertension and during treatment with corticosteroid drugs for prevention of edema (as a means of prevention). Means It is also prescribed for the prevention of the formation of stones in the urinary ways containing calcium.
Hypothiazide is used in adults from 25 to 50 mg once a day, in the form of monotherapy, or together with other hypotensive drugs. Sometimes a dosage of 12.5 mg is sufficient. For achievement the optimal effect may require a month of treatment, and after at the end of the course, the antihypertensive effect persists for a week, which is very convenient. As for edema, first you need to give a tablet of 100 mg per day once, or once every other day, and then a small dose as directed by a doctor.
Advantages and disadvantages
The undoubted advantage of the drug is a mild effect, low price, and the ability to take it only once a day, or in one day. Side effects must also be considered. This decrease potassium, magnesium, increased calcium in the blood plasma with all specific symptoms: from fatigue and irritability to muscle cramps. This exacerbation of cholecystitis and pancreatitis, dizziness, headache, occasionally occurring leukopenia and thrombocytopenia, and even urticaria and respiratory distress syndrome. Maybe with Hypothiazide intake and decreased potency. Overdose may cause tachycardia and lower blood pressure due to potassium loss can cause spasms of the calf muscles, nausea and vomiting The drug may interact with many other medicines. It enhances the effect of cardiac glycosides, and its effect on diuresis is weakened if taken along with non-steroidal anti-inflammatory drugs.
It is these diuretics that are known to everyone, since loopback diuretic refers to the well-known Furosemide, or Lasix. These the funds are quite powerful, but not for long. They also remove sodium, while increasing the release of the hormone renin, and activity of angiotensin-aldosterone system increases. Big the advantage of these diuretics is the ability to use them as emergency care in the treatment of edema in chronic heart insufficiency, with massive swelling in the legs, with ascites and with pulmonary edema.
All forms of loop diuretics are available both in ampoules and in pills. They are used intravenously, intramuscularly and orally. However, care must be taken as administration of furosemide in large doses, especially in elderly patients with heart rhythm disturbance due to a drop in potassium concentration in blood plasma, can cause an attack of atrial fibrillation, and in young patients – krampi, or night cramps in calves, also associated with leaching of potassium. Therefore, it is desirable together with loop diuretics take potassium preparations.
Popularity Rating: 4.9
Furosemide, aka Lasix, is the reference and most famous diuretic. Its cost is not high. Furosemide in standard 40 mg tablets are inexpensive and can be purchased even cheaper than 20 rubles. for 50 tablets. Because he constantly enters to the list of vital and essential medicines (ZhVNLS), then many pharmaceuticals produce it enterprises. This is the Macedonian alkaloid and the Bulgarian Balkanpharma, Belmedpreparaty and Biosynthesis, Dalchimpharm and Veropharm, Canonpharma production and Moscow endocrine plant, Novosibkhimpharm and Ozone, Danish Nycomed and Bulgarian Farmhim, the list goes on infinity.
The popularity of furosemide is that it is a loop diuretic, which acts quickly, strongly and briefly. It is very important when providing first aid. The medicine is highly active diuretics, and quickly helps restore fluid balance when diffuse edema, and even with advanced chronic cardiac failure, with cirrhosis, and with nephrotic syndrome. It is used constantly on ambulance for cardiac asthma and cerebral edema in pregnant women with eclampsia can reduce blood pressure in hypertensive crisis. In a word, this really very good, high-quality and cheap drug.
Take Furosemide for edema, first half tablets, from 20 mg, once a day. Then, if necessary, under strict medical supervision can increase the dosage taking into account the control of laboratory tests of potassium, sodium, magnesium and chlorine. It should be remembered that the maximum dose when taken orally is 6 mg per kilogram of body weight, so the maximum allowable dosage for a 100 kg adult – it is 600 mg per day, that is 15 tablets! But this is the ultimate dosage, and in practice it is almost never prescribed, and if appointed, then in hospitals under strict control. Besides of this, such a high dosage is received, seeing the inefficiency of small doses, gradually increasing it.
Advantages and disadvantages
The fast and active Furosemide has its own limitations. It can not be prescribed for severe hepatic and renal insufficiency, with obstruction of the urinary tract, including with urolithiasis, with stenosis and scar adhesions in the urethra and bladder. It is not prescribed for gout and hyperuricemia, high sugar, and hyperglycemic coma. It can not be used for decompensated valvular defects heart – with mitral and aortic stenosis. It is contraindicated in pancreatitis, and acute myocardial infarction.
There is a whole list of diseases and conditions in which Furosemide can be used, but only with great care. it prostate hyperplasia, diabetes, cerebral atherosclerosis, pregnancy and lactation. For pregnancy and breastfeeding Feeding is a well-known rule. Any medicine assigned only when the possible benefits of treatment will be exceed the potential risk to the unborn child.
Furosemide has many side effects and they are a continuation of its merits: speed and strength. It’s a sharp drop pressure, collapse and tachycardia, the occurrence of cardiac arrhythmia. This is dizziness and drowsiness, dry mouth and thirst, decreased potency and general dehydration. But more often than not, a quick reception furosemide (when administered intravenously) causes a sharp decrease potassium in blood plasma, and in elderly patients with rhythm disturbance may lead to paroxysm of atrial fibrillation. Therefore, when prescribing loop diuretics, you must immediately offset potential loss of potassium and magnesium by prescribing appropriate drugs (Panangin). It is clear that an overdose furosemide can lead to a sharp drop in pressure and shock, to the development of acute renal failure with anuria, or with complete lack of urine, to traumatic processes against the background of blood thickening etc. Conclusion: furosemide is very effective and useful, but only in experienced hands.
These medicines are called potassium-sparing diuretics. we have already said enough that the above diuretics remove sodium, but also they lead to a loss of potassium. Therefore the appearance a diuretic that prevents potassium loss was a real salvation for compromised groups of patients.
Of course, these diuretics have a weak diuretic effect, but but at the same time they retain potassium, and are indicated for the treatment of different common edema. This is nephropathy, gout, cirrhosis and diabetes mellitus, heart failure. These drugs taken internally, but expect any pronounced effect from them not worth it. They add the amount of urine released not at all times “, and somewhere around 1/5 of the original. That is, the patient, taking the drug, will urinate not 100%, as before, but by 120%. In addition, an assortment of potassium-sparing diuretics limited to almost the only drug – spironolactone.
Spironolactone (Veroshpiron, Vero-Spironolactone, Veroshpilacton, Aldacton)
Popularity Rating: 4.8
Veroshpiron, compared with Furosemide, is significantly weaker and “soft” diuretic. Its cost is low. Pack of 20 25 mg tablets will cost from 63 to 100 rubles. Produces Veroshpiron Hungarian company Gideon Richter. Veroshpiron’s Strength that he does not remove potassium from the body. Mechanism of action somewhat different, he competes with the hormone antagonist aldosterone called antidiuretic hormone. IN the renal tubule spironolactone increases urine output in sodium and chlorine.
Spironolactone reduces the acidity of urine, so it can used in the treatment of urolithiasis. Also he slightly reduces blood pressure, but not immediately, but somewhere on the third to fifth day of treatment. It is indicated for use in arterial hypertension, but always with others drugs. If we are talking about edema, then this is primarily – chronic heart failure but needs to be supplemented other drugs prescribed by the cardiologist. Since he is not “fills” potassium, then it is safer for various violations rhythm in the background of heart failure.
An important indication is secondary hyperaldosteronism, ascites and cirrhosis of the liver, which is accompanied by edema. It is also primary high levels of aldosterone, or Cohn’s syndrome, but it is prescribed only briefly, and before the operation. Prescribe Veroshpiron in a dosage from 50 to 100 mg once a day, followed by an increase in dose, but no more than 200 mg. The highest dosage required at hyperaldosteronism, and a pronounced decrease in potassium in the blood, up to 400 mg per day in two or three doses. The course of treatment for edema associated with heart failure, is about a week, you can longer, but by the decision of the doctor.
Advantages and disadvantages
The main advantage of Veroshpiron is the ability to save potassium, and this compares favorably with its powerful, but more rude looped “peers.” However, the medicine may have side effects such as nausea, lethargy, decreased white blood cells in plasma, increased creatinine and uric acid with urea, potassium retention, and even the appearance of coarsening of the voice in women and gynecomastia in men. In some cases, the drug may cause muscle spasm and baldness. Veroshpiron may affect with other medicines. Therefore it is advisable to avoid incompatibilities and side effects make it short courses, in recommended dosages and under supervision specialist.
Popularity rating based on analysis of demand data service wordstat.yandex.ru.
Attention! This rating is subjective, not advertising and does not serve as a guide to the purchase. Before the purchase consultation with a specialist is necessary.