Loop Diuretics: Producers of The Greatest Diuresis With Rhonda Lawes

Loop Diuretics
Producers of the Greatest Diuresis
With Rhonda Lawes
DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

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What Do Diuretics Do?
They increase
an effort to lower blood pressure and/or
decrease edema.

Nephron
Glomerulus
• Functional unit of the kidney
• Each kidney has ~1,000,000 nephrons capsule
• Nephrons stretch from the cortex to the

medulla of the kidney
• Nephron has three main parts:
• Tubule (PCT & DCT) Collecting

duct
• Glomerulus
Urine to
• ureter and
beyond
© by Lecturio DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Diuretic Sites of Action in the Nephron
Carbonic Glomerulus Na+Cl-
Thiazides
anhydrase (5 %)
inhibitors
K+-sparing
diuretics
Na+ DCT
(65 70 %) PCT (1 5 %)
Na+
TAL
Cortex K+N+
Medulla Na+K+
Loop
2 Cl- Collecting
diuretic
(25 %) duct
Loop of
Henle Urine
excretion
© by Lecturio DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Loop Diuretics: MOA
• Example: Furosemide (Lasix)
• Site of action: thick ascending limb of the

loop of Henle
• Produces the highest loss of fluid and electrolytes Furosemide

Injection, USP
• Blocks reabsorption of sodium, chloride, and
potassium

Loop Diuretics
IV PO IM
Route determined by urgency of fluid mobilization
Can increase urine Can increase output

output as quickly as in 60 min and
5 min and continues continues for 8 h
for 2 h

Loop Diuretics
IV PO IM
• Used when critical removal of fluid is required
• Pulmonary edema, renal failure, CHF, or liver failure
• Effective even with low renal blood flow and GFR
• Monitor patient for signs of dehydration

What are the signs and symptoms of
dehydration a nurse should monitor for?
Rawpixel, CC0DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Signs and Symptoms of Dehydration
Dry Excessive Oliguria Dark

(small amounts
mouth thirst of urine) urine
Severe dehydration can lead to hypovolemia, low blood

pressure and shock. This also puts the patient at risk to develop clots.

Loop Diuretics Adverse Effects
Most common Other
• Excessive loss of electrolytes (Na+, Cl-) • Hyperglycemia

and water
• Hyperuricemia
• Hypotension
• Avoid in pregnancy
• Low potassium (
• Can raise LDL and lower HDL
• Ototoxicity IV push: very slow
• Increases excretion of magnesium and
calcium

Low Mg Low Ca
Muscle weakness,
Tetany
tremors, or dysrhythmias
What are the symptoms of hypomagnesia

and hypocalcemia a nurse should monitor for?
F.l.t.r.: aixklusiv, CC0; Bommie,
DARRYL CC0
JOHN PASAMBA, pasambad1306@uerm.edu.ph
Digoxin + Furosemide
Digoxin is used to treat CHF.
Low potassium, for any reason,

increases risk of digoxin toxicity.
Furosemide (Lasix)
can cause
hypokalemia (low potassium).

Patient Case 1
Mr. George is a 83-year-old male patient who has been diagnosed with
congestive heart failure, diabetes, hypertension, and gout. He currently
takes digoxin and furosemide (Lasix) daily. His weight is up 5 pounds over
the last two days and the physician has ordered an increased dose of
furosemide.
Why has the Health Care Provider (HCP) ordered an increased

A dose of furosemide?
Increased weight indicates edema.

Patient Case 1
furosemide.
What impact does furosemide have on the symptoms of CHF?

B Diabetes? Hypertension? Gout?
Furosemide (Lasix) will increase fluid mobilization, possibly raise blood

sugar, decrease hypertension and may aggravate gout.

Patient Case 1
furosemide.
What risks or adverse effects should the nurse monitor for Mr. George in
C order to keep him safe and ensure the most effective treatment?
Listen to lung sounds, monitor FSBS more often, monitor BP, educate
about orthostatic hypotension, educate to report increased symptoms of
gout. Also educate patient re: s/s low potassium and digoxin toxicity (GI
problems, yellow halos/vision disturbances,

Patient Case 2
Mrs. Wright is a 68-year-old female patient with a history of congestive
heart failure who is taking furosemide (Lasix), digoxin, and hydralazine
daily.
She has developed an infection with Staphylococcus aureus and an
urgent care physician would like to prescribe gentamicin.
A What is gentamicin?
It is an antibiotic in the aminoglycoside family.

Patient Case 2
Mrs. Wright is a 68-year-old female patient with a history of congestive
heart failure who is taking furosemide (Lasix), digoxin, and hydralazine
daily.
She has developed an infection with Staphylococcus aureus and an
urgent care physician would like to prescribe gentamicin.
As
B diagnoses and/or medications?
Gentamicin is ototoxic, so it should not be given with Lasix.

Consider an alternative that is not ototoxic

Patient Case 3
Mr. Smith has been diagnosed with bipolar disorder, HTN, diabetes and
is newly diagnosed with CHF. He takes lithium, enalapril, and insulin daily.
He will now begin taking furosemide (Lasix).
What are the most important concepts to educate Mr. Smith about the
A impact of furosemide with his current medications?
Lithium + furosemide = risk for lithium toxicity

Enalapril + furosemide = risk for hypotension
Insulin + furosemide = risk for hyperglycemia

Patient Case 3
Use of furosemide can cause electrolyte imbalances of potassium,

B calcium, sodium, and magnesium. What particular imbalance is most
concerning with lithium?
Furosemide can lower Na low sodium leads to less lithium excretion

and increased risk of lithium toxicity.

Patient Case 3
C What signs/symptoms would need immediate follow-up?
Signs and symptoms of lithium toxicity are: GI distress (nausea, vomiting,

diarrhea) tremors, muscle weakness, drowsiness seizures, agitation,
slurred speech, hypotension.

In a Nutshell
 Loop diuretics block sodium and chloride

loop of
Henle.
 Loop diuretics produce the highest loss of

fluid and electrolytes.
 Furosemide (Lasix) is an example of a loop

diuretic.
 Bumetanide, ethancrynic acid and

torsemide are also loop diuretics.

In a Nutshell
 Loop diuretics can cause hypotension by

decreasing volume and relaxing venous
smooth muscles.
 Loop diuretics also cause electrolyte

imbalances, hearing loss, elevated blood
sugar, elevated uric acid levels, and should
be avoided in pregnancy.

This document is a property of: DARRYL JOHN PASAMBA
Note: This document is copyright protected. It may not be copied, reproduced, used, or
distributed in any way without the written authorization of Lecturio GmbH.


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Loop Diuretics

Producers of the Greatest Diuresis

With Rhonda Lawes

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

• Each kidney has ~1,000,000 nephrons capsule

• Nephrons stretch from the cortex to the

• Nephron has three main parts:

• Tubule (PCT & DCT) Collecting

Powered by TCPDF (www.tcpdf.org)

Powered by TCPDF (www.tcpdf.org)

• Example: Furosemide (Lasix)

• Site of action: thick ascending limb of the

• Produces the highest loss of fluid and electrolytes Furosemide

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Route determined by urgency of fluid mobilization

Can increase urine Can increase output

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

• Used when critical removal of fluid is required

• Pulmonary edema, renal failure, CHF, or liver failure

• Effective even with low renal blood flow and GFR

• Monitor patient for signs of dehydration

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Powered by TCPDF (www.tcpdf.org)

Dry Excessive Oliguria Dark

Severe dehydration can lead to hypovolemia, low blood

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

• Excessive loss of electrolytes (Na+, Cl-) • Hyperglycemia

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

What are the symptoms of hypomagnesia

Digoxin is used to treat CHF.

Low potassium, for any reason,

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Why has the Health Care Provider (HCP) ordered an increased

Increased weight indicates edema.

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

What impact does furosemide have on the symptoms of CHF?

Furosemide (Lasix) will increase fluid mobilization, possibly raise blood

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

It is an antibiotic in the aminoglycoside family.

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Gentamicin is ototoxic, so it should not be given with Lasix.

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Lithium + furosemide = risk for lithium toxicity

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

Use of furosemide can cause electrolyte imbalances of potassium,

Furosemide can lower Na low sodium leads to less lithium excretion

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

C What signs/symptoms would need immediate follow-up?

Signs and symptoms of lithium toxicity are: GI distress (nausea, vomiting,

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

 Loop diuretics block sodium and chloride

 Loop diuretics produce the highest loss of

 Furosemide (Lasix) is an example of a loop

 Bumetanide, ethancrynic acid and

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

 Loop diuretics can cause hypotension by

 Loop diuretics also cause electrolyte

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

DARRYL JOHN PASAMBA, pasambad1306@uerm.edu.ph

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