Sie sind auf Seite 1von 24

Journal Reading

The Effect of Furosemide on Arterial Blood


Pressure, Blood Glucose Level and
Incidence of Heart Arrhythmias
Elvidin Osmanovic, Esed Omerkic, Semir Imamovic, Mirza
Mukinovic, Halid Mahmutbegovic and Mersiha Cerkezovic

Enrico Chaesan Tanzil (406172083)


Pembimbing :
dr. Eddy Mulyono Sp PD, FINASIM
RSUD RAA Soewondo, Pati
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Journal Identity

 Title : The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose


Level and Incidence of Heart Arrhythmias
 Written by : Elvidin Osmanovic, Esed Omerkic, Semir Imamovic, Mirza
Mukinovic, Halid Mahmutbegovic and Mersiha Cerkezovic
 Published by : Science Publishing Group, American Journal of Internal
Medicine
 Year : 2017
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Introduction
 Potassium is taken into our body system through food (50-100mmol/day) and it
is distributed in the body fluids.
 The majority (98%) of potassium is placed in the cells, while only 2% is in
extracellular fluid  concentration of potassium in the cellular fluids of 140-
150 mmol/L, while in extracellular fluid the concentration is 3.5-5.0 mmol/L.
 This gradient concentration of potassium is formed and maintained by the Na/K
pumps.
 Insulin enhances operation of the Na/K pumps and in that way enhances
entering of potassium into the cell itself.
 In case that potassium in the body system, this condition leads to potassium
deficiency (hypocalemia) that reduce secretion of insulin in the body and as a
result of that blood glucose levels increases.
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Introduction
 Level of potassium also affects the heart rate while potassium deficiency
(hypocalemia) can lead to fast heart rate.
 In the ECG potassium deficiency is manifested as SVT.
 Furosemide is a diuretic and is often used in the treatment of hypertension.
 This is also drug of choice when it comes to the stage of hypertensive
urgencies and emergencies.
 Due the fact this medicine causes a loss of potassium ions it can also affect
the reduction of insulin in the blood, and thus the increase in blood glucose
and arrhythmias.
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

The Aim of this paper is :


1. An effect of furosemide onto hypertension treatment and crisis.
2. To determine hypertensive crisis in patient suffering from hypertension and
diabetes.
3. To determine the frequency of arrhythmic heart disorders before and after
antihypertensive treatment of furosemide.
4. To identify the difference in blood glucose levels before and after
antihypertensive treatment of furosemide.
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Methods

 Prospective Random Study


 February to July 2016 in Emergency Medical Services of Public Health Institution Center
Zivinice, Bosnia and Herzegovina
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Methods
Inclusion Criteria Exclusion Criteria

A disease that can cause disturbance of potassium


High Blood Pressure
and glucose levels (except for diabetes)

High Blood Glucose Surgical procedures on the heart and blood vessels

18-80 years of age Disease of pancreas

Non-smokers The existence of recent acute stress reactions

Use the medicine that can affect the level of blood


Not drinking alcohol
glucose and cardiac arrhytmias

Last meal consumed before 6 or more hours.


The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Methods
Group 1
• The first group of patient which were suffering from hypertension

Group 2
• The second group which includes hypertensive patients who suffered from co-morbidities diabetes

Group 3 ( Control )
• The third ( Control ) group of patients are patients which suffered from high blood pressure, but they have not
been diagnosed with hypertension and diabetes
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Methods

 All data were analyzed using descriptive statistic


 Statistical analysis was performed using MedCalc for Windows ver 12.4.0 and for the most
part using SPSS Statistics ver 17.0
 𝑃 value of <0.05
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and
Incidence of Heart Arrhythmias. American Journal of Internal Medicine
2017;5(3) 41-45

Results
 The study included a total of 120 patients, of whom 59 (49.1%) were men 61 (50.9%) woman
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Results

• After the treatment of furosemide, the lowest value of arterial blood pressure had
patients with ab elevated arterial blood pressure without diagnosed hypertension
with an average value of 118/80.
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Results
• According to ANOVA analysis for all three observed group of patients, after
treatment of furosemide there is no statistical in the incidence of
arrhythmias between the groups where p = 0,202.
• When looking within each group between men and woman, there is not
statistical significance in the incidence of arrhythmias before and after
therapy, where p = 0.709.
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Results
• After admission to Emergency Medical Service, the highest level of
blood glucose was noticed in the group of patients who are suffering
from hypertension and diabetes, with an average value of 11.9
mmol/L.
• While in the group patients who suffering from high arterial blood
pressure without diagnosed hypertension and diabetes, the average
blood glucose value was the lowest 6.7 mmol/L (p=0.009)
Results

 It is observed that after treatment of furosemide, there is no statistically significant


difference in blood glucose values between the two sexes.
 Observed between group there is no statistically significant difference in an increase of
blood glucose after treatment with furosemide (p <0.09).
 Looking at the summary for all three group of patients, the average value of increase of
blood glucose after treatment with furosemide is 0.7 mmol/L, which is not statistically
significant (p= 0.3)
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Discussion
 Hypertension is the most severe cardiovascular disorder in European countries
with high income, where hypertension was observed in 20% to 50% of the adult
population.
 It was determined that half of the half of the respondents knew that they are
suffering from hypertension , but they are not use anti hypertensive therapy.
 More than half the adult population is overweigh (BMI from 25 to 29.9) or
obese (BMI > or = 30)
 The combination of high BMI with high arterial blood pressure is statistically
significant
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Conclusion

 Furosemide is a very effective medicine for the rapid lowering of blood pressure.
 Furosemide is safe for the treatment of hypertension in diabetic patients
 It does not cause an increase in blood glucose levels.
Critical Appraisal
The Effect of Furosemide on Arterial
Blood Pressure, Blood Glucose Level and
Incidence of Heart Arrhythmias
Judul Jurnal

 Judul 16 kata  Lebih dari 12 kata


 Judul menggambarkan isi penelitian
 Judul dibuat dengan kalimat yang sederhana,
 Tidak menggunakan singkatan
 Menggunakan kalimat positif
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Abstrak

Mencakup komponen IMRD (Introduction, Methods,


Result, Discussion)
Jumlah kata : 279 kata  lebih dari 250 kata
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

PICO

Patient
• Patient with hypertension heart disease
and diabetes
Intervention
• Furosemide 20mg / 2ml IV twice a day
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

PICO

Comparasion
• Patient with hypertension heart disease and
diabetes
Outcome
• Furosemide is safe for the treatment of
hypertension in diabetic patient.
• It does not cause an increase in blood glucose level.
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Bukti Valid
Pertanyaan
Apakah alokasi pasien pada penelitian ini dilakukan
Ya
secara acak?
Apakah pengamatan pasien dilakukan secara
Ya
lengkap?
Apakah semua pasien dalam kelompok yang diacak,
Ya
dianalisis?
Apakah pasien dan dokter tetap blind dalam
Tidak
melakukan terapi?
Apakah kelompok diperlakukan sama selain dari
Ya
terapi yang diuji?
Apakah kelompok terapi dan kontrol sama? Ya
The Effect of Furosemide on Arterial Blood Pressure, Blood Glucose Level and Incidence of Heart
Arrhythmias. American Journal of Internal Medicine 2017;5(3) 41-45

Applicability
APPLICABLE
Apakah pada pasien kita terdapat perbedaan
bila dibandingkan dengan yang terdapat pada
Tidak
penelitian sebelumnya sehingga hasil tersebut
tidak dapat diterapkan pada pasien kita?
Apakah pemberian terapi tersebut mungkin
Ya
dapat diterapkan pada pasien kita?
Apakah pasien memiliki potensi yang
menguntungkan pemberian terapi tersebut Ya
diterapkan?
Terima Kasih