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Diuretic Therapy

Explore the contrasting uses of diuretics in operating rooms versus critical care settings in this comprehensive lecture series covering renal anatomy, physiology, nephron function, hormonal regulation, and diuretic classification. Learn about diuretic sites of action, intra-operative uses, rhabdomyolysis, and genetic predispositions, as well as diagnosis and treatment strategies including adjuvant therapies.

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Diuretic Therapy

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  1. Diuretic Therapy

  2. Overview • Contrasting uses of diuretics in OR versus Critical Care • Lecture sections: - Anatomy & Physiology - Renal Effects of Anesthesia Drugs - Diuretic Drugs by Class - Intra-operative Uses - Adjuvant Therapy

  3. Renal Anatomy • Size • Regions • Functional Unit • Blood Supply • Tubular Systems • Hemodynamics • Hydraulics

  4. Structure

  5. Renal Physiology • Filtration • Reabsorption • Secretion • Minor functions

  6. Nephron

  7. Tubular segment characteristics

  8. Juxta-glomerular complex

  9. Nephron

  10. Counter-Current Mechanism • What is it? • How does it work? • Why is this so important?

  11. Counter-current mechanism in kidney

  12. Tubular fluid osmolarity

  13. Hormonal Regulation • Anti-diuretic Hormone (ADH) • Aldosterone • Renin-angiotensin • Atrial Natriuretic Peptide (ANP) • Prostaglandins • Epinephrine/Nor-epinephrine • Dopamine

  14. Anti-diuretic hormone feedback

  15. Aldosterone & renin-angiotensin

  16. Responses to Anesthetic Agents • Inhaled agents • Intravenous agents • Regional anesthesia

  17. Diuretic Classification • Osmotic agents • Carbonic Anhydrase Inhibitors • Loop Diuretics • Aldosterone Antagonists • Potassium-sparing Agents • Thiazide Diuretics • Xanthines

  18. Diuretic sites of action

  19. Intra-operative Uses • ICP reduction • IOP reduction • Renal failure prophylaxis • Oliguria assessment & treatment • General strategies

  20. Rhabdomyolysis • Peaked T-waves • Myoglobinuria

  21. Causes • Muscle trauma/ischemia/exertion • Substance abuse • Medication • Toxins • Electrical injury • Hyperthermia • Infections • Transfusions • Electrolyte disorders

  22. Genetic disposition • Glycolysis defect • Lipid metabolism defects • Mitochondrial myopathies • Muscular dystrophies • G-6-PD deficiency • Collagen vascular disorders

  23. Diagnosis • History • Deteriorating renal function • Tea-colored urine • Peaked T-waves • Evidence of coagulopathies

  24. Treatment • IV fluids • Electrolyte correction • Acid-base correction • Diuretics • Dialysis or hemofiltration • Correction of underlying problems

  25. Adjuvant Therapy • Fenoldopam • N-acetylcysteine • Nesiritide

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