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Diuretic Therapy

Diuretic Therapy. 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. Renal Anatomy. Size Regions Functional Unit

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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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