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[Bumetanide in renal insufficiency]

L Humair

    Schweizerische Medizinische Wochenschrift
    |February 27, 1982
    PubMed
    Summary

    Intravenous bumetanide effectively promotes water and sodium excretion in patients with severe renal insufficiency, though with a delayed onset. This potent diuretic shows minimal potassium loss and acts on the loop of Henle.

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    Area of Science:

    • Nephrology
    • Pharmacology
    • Cardiology

    Context:

    • Patients with cardiac and renal failure often experience fluid overload.
    • Severe renal insufficiency (creatinine clearance < 12 ml/min) complicates diuretic management.
    • Intravenous bumetanide is a loop diuretic used in managing fluid retention.

    Purpose:

    • To evaluate the efficacy and characteristics of intravenous bumetanide in patients with severe renal insufficiency and cardiac failure.
    • To assess the onset, duration, and electrolyte effects of bumetanide in this patient population.

    Summary:

    • Intravenous bumetanide administration in patients with cardiac and renal failure (creatinine clearance < 12 ml/min) resulted in delayed diuresis and natriuresis, typically occurring 2-3 hours post-injection.
    • The drug's primary action was identified at the loop of Henle, with evidence suggesting a potential effect on the distal tubule due to increased filtered sodium excretion.
    • Potassium loss was minimal, and one patient with terminal renal failure (creatinine clearance 2 ml/min) and pericarditis did not respond to the treatment.

    Impact:

    • Bumetanide demonstrates effectiveness in managing fluid overload in severe renal insufficiency, despite delayed action.
    • Understanding the pharmacodynamics of bumetanide in renal impairment is crucial for optimizing patient care.
    • The study highlights the variability in response to bumetanide, particularly in end-stage renal disease.

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