Indications For Diuretics

• Oedema states associated with sodium overload, e.g. cardiac, renal or hepatic disease, and also without sodium overload, e.g. acute pulmonary oedema following myocardial infarction. Note that oedema may also be localised, e.g. angioedema over the face and neck or around the ankles following some calcium channel blockers, or due to low plasma albumin, or immobility in the elderly; in none of these circumstances are diuretics indicated.

• Hypertension, by reducing intravascular volume and probably by other mechanisms too, e.g. reduction of sensitivity to noradrenergic vasoconstriction.

• Hypercalcaemia. Frusemide reduces calcium reabsorption in the ascending limb of the loop of Henle and this action may be utilised in the emergency reduction of elevated plasma calcium in addition to rehydration and other measures (see p. 740).

• Idiopathic hypercalciuria, a common cause of renal stone disease, may be reduced by thiazide diuretics

• The syndrome of inappropriate secretion of antidiuretic hormone secretion (SIADH) maybe treated with frusemide if there is a dangerous degree of volume overload, (see also p. 713).

• Nephrogenic diabetes insipidus, paradoxically, may respond to diuretics which, by contracting vascular volume, increase salt and water reabsorption in the proximal tubule, and thus reduce urine volume.

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Constipation Prescription

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