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diuretic resistance

diuretic resistance is > 240 mg furosemide equivalent daily Etiology: - renal failure, cardiorenal syndrome [1,2] Pathology: - delayed peak concentrations of loop diuretics in the renal tubules - increasing loop diuretic can stimulate sodium & water retention in downstream nephrons Management: - metolazone 5 mg bid while maintaining loop diuretic dose - tolvalptin 30 mg qd associated with less hyponatremia than metolazone [2] - increasing loop diuretic can worsen symptoms of fluid overload

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References

  1. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  2. Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic strategies for loop diuretic resistance in acute heart failure: The 3T trial. JACC Heart Fail 2019 Dec 11; PMID: 31838029