Diurétique

A diuretic is a substance which will increase the production of Urine.

  • Some are used like Médicament S: they inhibit the reabsorption of the ions Sodium and thus of water by the Rein.

  • the others are qualified substances for purpose diuretic:

Classifications

There exist 2 manners of classifying the diurétiques ones

Classification according to the site of action at the renal level

There exist three families of diuretic, none not operating the tube circumvented proximal.

  1. the Diurétiques of the handle, which act on the level of the Anse of Henle.

  2. the thiazidic Diurétiques, which act on the level of the cortical segment of dilution.
  3. the Diurétiques hyperkaliémiants, which act on the level of the distal circumvented tube and the collecting tube:
    1. either Diurétiques anti-aldosterone,
    2. or Diurétiques inhibiters of the channel of sodium.

According to the action on the Kaliémie

this action depends on their action on site 4:
  1. Diurétiques hypokaliémiants (supporting the elimination of potassium in the urines):
    1. Diurétiques of the handle,
    2. Diurétiques thiazidic.
  2. Diurétiques hyperkaliémiants (saving the elimination of potassium in the urines).

Indications in medicine

The principal indications are:

  • the Cardiac failure: allows to decrease blood volume and thus, cardiac work,
  • the arterial hypertension: reduction in blood volume and thus in the pressures,
  • the syndromes œdémateux without local cause
  • Certain renal pathologies

The use of the diuretic is hardly justified in:

  • obesity: the lost weight corresponds to water and not to grease.
  • oedemas of local origin (compression, bad venous state…)

Counter-indications

  • impaired renal function for diuretic the hyperkaliémiants and diuretic thiazidic
  • allergy to sulphamides (thiazidic, diuretic of the handle), etc
  • gravidic toxaemia (rejected by the majority of the authors)

Medicamentous interactions

Interactions are in particular possible with the following drugs: digitalic, hypotenseurs, salts of lithium, antivitamines K, anti-inflammatory drugs not stéroïdiens, certain antibiotics.

Undesirable effects

  • dehydration, hypotension, functional impaired renal function,

  • hyperuricemy (rate of uric acid in blood higher than the normal), disorders lipidic,
  • thirst,
  • alcalose metabolic,
  • deafness (diuretic of the handle),
  • genital endocriniens effects (anti-aldosterones).
  • for the thiazidic Diurétiques and the Diurétiques of the handle: hyponatremy (sodium rate in blood lower than the normal), Hypokaliémie (potassium rate in blood lower than the normal)
  • for diuretic the épargneurs of potassium: hypomagnesemy (magnesium rate in blood lower than the normal), Hyperkaliémie (potassium rate in blood higher than the normal)

Monitoring of the treatment

A clinical and biological monitoring is necessary in the course of treatment. It must be attentive for the elderly, particularly exposed with the undesirable effects (orthostatic hypotension, dyskaliemy…).

The monitoring includes/understands in particular the examination of the following points:

  • curve of weight and curve of diuresis,
  • importance of the oedemas,
  • blood pressure (in décubitus and upright posture),
  • urinary sodium the 24 hours,
  • ionogramme blood (in the search in particular of a modification of Na+ and K+),
  • uricemy, glycemia,
  • ECG (in the event of associated digitalization).

Principal diuretic

  • Diurétiques of the handle: Furosémide …

  • Diurétiques thiazidic
  • Diurétiques épargneurs of potassium: Spironolactone …
  • Diurétiques osmotic
  • Other substances for purpose diuretic
  • See also: List of the medicinal plants by therapeutic indication

Simple: Diuretic

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