Diuresis forced

A variety of therapies for thallium poisoning have been suggested by neutralising thallium in the intestinal tract, hastening excretion after resorption, or decreasing absorption. Berlin-Blue (fertihexacyanate) and sodium iodide in a 1 wt % solution have been recommended. Forced diuresis hemoperfusion and hemodialysis in combination results in the elimination of up to 40% of the resorbed thaHous sulfate (39). 

In normal human subjects, ANP infusion for one hour causes increased absolute and fractional sodium excretion, urine flow, GFR, and water clearance (53—55). As shown in many in vitro and in vivo animal studies, ANP achieves this by direct effect on the sodium reabsorption in the inner medullary collecting duct, ie, by reducing vasopressin-dependent free-water and sodium reabsorption leading to diuresis and by indirect effect through increased hemodynamic force upon the kidney. ANP inhibits the release of renin and aldosterone resulting in the decreased plasma renin activity and aldosterone concentration (56,57). 

Cisplatin administration requires adequate hydration and forced diuresis to prevent kidney damage. Cisplatin is intensely emetogenic and its use requires adequate antiemetic prophylaxis. Myelosuppression is less evident than with other alkylating agents. 

Forced diuresis with either a loop diuretic or mannitol... 

Forced diuresis in patients with adequate renal function... 

Hemodialysis is the treatment of choice for patients with renal dysfunction. Forced diuresis with saline and loop diuretics is the treatment of choice for patients with adequate renal function. 

Cardiac arrhythmia has also been noted in rabbits treated with 2 mL of a 50% phenol solution on a 15-cm2 area (23.8 mg/cm2/kg) (Wexler et al. 1984). Reducing plasma concentrations of phenol by forced diuresis or a longer application time reduced the cardiac effects. 

The symptoms of overdose are to some extent predictable from the antimuscarinic and adrenolytic activity of these drugs. Excitement and restlessness, sometimes associated with seizures, and rapidly followed by coma, depressed respiration, hypoxia, hypotension and hypothermia are clear signs of TCA overdose. Tachycardia and arrhythmias lead to diminished cardiac function and thus to reduced cerebral perfusion, which exacerbates the central toxic effects. It is generally accepted that dialysis and forced diuresis are useless in counteracting the toxicity, but activated charcoal may reduce the absorption of any unabsorbed drug. The risk of cardiac arrhythmias may extend for several days after the patient has recovered from a TCA overdose. 

Forced diuresis is occasionally useful. It may cause volume overload or electrolyte disturbances. Forced diuresis is useful for phenobarbital, bromides, lithium, salicylate, or amphetamines overdoses. Do not use for tricyclic antidepressants, sedative-hypnotics, or highly protein-bound medications. The most common agents employed are furosemide and osmotic diuretics with mannitol. 

Elimination of absorbed substances may be accomplished by administering multiple dose activated charcoal for poisons with entero-hepatic recirculation or by altering urine pH to promote excretion. Forced diuresis, if warranted, should only be done after carefully exercising precautions such as the provision of adequate hydration and maintaining electrolyte balance. 

Forced diuresis should be considered carefully in patients with an impaired ability to handle fluid loads and with electrolyte imbalances, particularly those with renal and heart failure and at the extremes of age. 

Drugs and poisons can in principle be removed from the systemic circulation by forced osmotic diuresis. These are theoretical concepts used in the... 

Consider forced diuresis, urine acidification, or alkalinization if specific antidotes are not available Hemodialysis or charcoal hemoperfusion may be appropriate for rapid elimination if antidotes are not available... 

Forced diuresis by furosemide, mannitol etc. and altering the urinary pH- increasing the pH of urine favours ionisation of acidic drugs like salicylates, phenobarbital etc. whereas reducing the pH favours ionisation of basic drugs like pethidine, amphetamine etc. 

Forced diuresis Diuretics like mannitol and furosemide can be used. 

In the management of refractory edema, the high ceiling diuretics may be used in conjunction with other types of diuretics. They are also useful for forced diuresis in hypnotic or other poisonings. 

Not all experts recommend forced diuresis and urinary pH manipulation after methamphetamine overdose because of the risk of renal damage. 

Previously popular but of unproved value, forced diuresis may cause volume overload and electrolyte abnormalities and is not recommended. Renal elimination of a few toxins can be enhanced by alteration of urinary pH. For example, urinary alkalinization is useful in cases of salicylate overdose. Acidification may increase the urine concentration of drugs such as phencyclidine and amphetamines but is not advised because it may worsen renal complications from rhabdomyolysis, which often accompanies the intoxication. 

A 23-year-old woman took chlorpropamide 5-10 g. She needed assisted respiration and cardiac pacing for bradycardia (probably due to blockade of potassium channels), fluid infusion, and forced diuresis for 3 days. Notwithstanding continuous glucose infusion and glucose boluses she relapsed into severe hypoglycemia with convulsions. Only on day 27 was her urine free of chlorpropamide and her blood glucose normal. 

A 73-year-old woman had rhabdomyolysis, cholestatic hepatitis, and mild renal insufficiency 14 days after she started to take the centrally acting muscle relaxant chlorzoxazone while also taking simvastatin (79). Withdrawal of the causal medication and conservative therapy with volume substitution and forced diuresis was followed by almost complete resolution of the symptoms. 

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