Congestive heart feilure

The nonsalicylate NSAIDs can also affect renal function. Risk factors fc>r NSAID-induced acute renal failure include congestive heart feilure, glomerulonephritis, chronic renal insufficiency, cirrhosis, systemic lupus erythematosus, diabetes mellitus, significant atherosclerotic disease in the elderly and use of diuretics. NSAIDs can adversely affect cardiovascular homeostasis and can be a risk factor for the onset or exacerbation of heart feilure. 

Because side effects can complicate the use of corticosteroids, a careful history and certain tests may be advisable, particularly if a patient may require prolonged ocular therapy. Steroids should be used with great caution in patients with diabetes mellitus, infectious disease, chronic renal feilure, congestive heart feilure, and systemic hypertension. Systemic administration is generally contraindicated in patients with peptic ulcer, osteoporosis, or psychoses. Topical steroids should be used with caution and only when necessary in patients with glaucoma. 

Mannitol is an intravenous hyperosmotic (1.5 to 2 g/kg intravenous as 20% solution [7.5 to 10 miykg] or as 15% solution [10 to 13 miykg]) over a period as short as 30 minutes. Cardiovascular status must be carefully evaluated before rapid administration of mannitol because a sudden increase in extracellular fluid may lead to fiilmi-nating congestive heart feilure. 

Cheng AYY,FantusIG. Thiazolidinedione-induced congestive heart feilure../4/m i/2er(2004)38, 817-20. 

Sc iportive treatment of congestive heart feilure (In horses) and liver insufficiency (in all species) may be helpful. 

NSAIDs should be avoided in patients with chronic renal insufficiency due to the risk of inducing further kidney damage. In patients at risk, acute renal feilure can occur after a single dose of drug. Risk fectors include dehydration, hypertension, congestive heart failure, concomitant use of angiotensin-converting enzyme inhibitors, and advanced age. 

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