Diuretic drug. Diuretics (diuretics). Causes of water retention in tissues

To remove excess water from the body, its cleansing and normalization acid-base balance diuretics are used. They are also called diuretics. Issued as synthetic drugs, and on plant based. Prescribed for hypertension, heart, kidney and liver diseases, which are accompanied by edema.

Diuretics - what are they?

• After a hypertensive patient takes a diuretic, sodium salts are retained in the body, excess water is removed, after some time the pressure becomes normal and remains for a long time.
• Thanks to the use of diuretics, it is possible to normalize fundus pressure, as well as intracranial pressure.
• They can inhibit the action of neurons, thereby preventing epilepsy attacks.
• Some drugs act as protectors and become a kind of protection for the kidneys and. Others can relax the muscles of the muscles, thereby relieving spasms in them.
• They reduce calcium levels in the blood, but retain magnesium. This improves microcirculation in the kidneys and relieves the load on the left ventricle of the heart, protecting the organs from complications.
• They can alleviate the condition of a patient who has been poisoned by toxic substances.

Classifications of diuretics

All diuretics are classified. They are divided depending on their origin. They can be:

• Chemical . Available in the form of tablets and powders, solutions for intravenous administration.
• Natural origin . Herbs and teas are used for diuretic purposes plant origin, as well as food.

• Potent drugs necessary when providing emergency assistance, decrease blood pressure blood. They are mainly used once.
• Medium strength , having a long-term effect, are part of the therapy for the treatment internal organs- kidneys, hearts. They are used in courses.
• Weak drugs , controlling fluid accumulation, but preserving potassium in the body.

Thiazide diuretics

Thiazide diuretics may affect the distal tubules of the kidneys, resulting in the following:

• Reabsorption (reabsorption) of chlorine and sodium is suppressed.
• The excretion of potassium and magnesium increases.
• Selection is reduced uric acid and excretion of calcium ions and urine.

• congestive heart failure;
• essential hypertension;
• kidney and liver diseases;
• glaucoma and so on.

• Indapamide;
• Indap;
• Metolazone;
• Klopamide;
• Chlorthalidone.

To reduce side effects Depending on the prescribed dose, thiazide diuretics are prescribed together with loop diuretics.

Potassium-sparing diuretics

They are prescribed for the following symptoms:

• heart failure;
• potassium-sparing diuretic therapy;
• the appearance of edema (see also -).

• Veroshpiron;
• Spironolactone;
• Aldactone.

To avoid such hormone-related side effects, you can take Amiloride and Triampur. They affect everyone equally. At the level of the distal tubules, potassium is inhibited and magnesium is removed from the body. Therefore, these drugs produce a potassium-sparing effect. But they also have side effects– hyperkalemia occurs when taking them. Potassium passes from the cells into the blood. Its increase in large quantities can cause cardiac arrest or lead to muscle paralysis.

It is especially dangerous to prescribe these drugs to patients diagnosed with diabetes mellitus and renal failure. These medications should not be taken without the supervision of a physician and the dose should not be increased independently.

What are loop diuretics?

• reduce the activity of reabsorption of potassium, sodium, chlorine, magnesium;
• relax the muscles of blood vessels;
• enhance glomerular filtration;
• increase blood flow in the kidneys;
• affect hemodynamic readings, especially if drugs are administered intravenously;
• may gradually reduce the volume of extracellular fluid.

• cerebral edema;
• hyperkalemia;
• pulmonary edema;
• heart and kidney failure;
• hypertensive crisis;
• cirrhosis of the liver.

• Ethacrynic acid;
• Furosemide;
• Piretanide;
• Bumetanide.

Osmotic diuretics

The following drugs are classified as osmotic drugs:

• Sorbitol;
• Urea;
• Mannitol.

But taking them leads to side effects, these include:

• the occurrence of pain in the head;
• tissue necrosis if the drug gets under the skin;
• increase in blood nitrogen;
• nausea.

Herbal diuretics

Love for spicy, salty, fatty foods, ill health of the kidneys, venous or cardiovascular systems, pregnancy, acute allergy, too much long walk wearing heels in hot weather – there are more than enough reasons for swelling.

Because of excess liquid The ankles and fingers swell, the face becomes puffy, and the legs hurt unbearably. Of course, nothing prevents you from resorting to the help of pharmaceutical diuretics. But there is a more gentle way - to include diuretic products in your diet.

Swelling caused by short-term circumstances will not cause much harm. If you were forced to spend several hours without moving (for example, during an air flight or at a work computer), then a short 15-minute walk will easily bring you back to normal.

It is much worse if the liquid stagnates due to bad work internal organs. With such edema, you will need to consult a doctor: excess fluid increases blood pressure, impairs the functioning of all body systems, and disrupts the circulation of lymph and blood. In addition, with edema, dehydration is often observed: waste fluid stagnates, forcing you to consume less fresh water, which the body actually needs.

A common occurrence is swelling during pregnancy. Some experts call them physiological norm in the third trimester of pregnancy. Indeed, their appearance is easy to explain: the baby grows, and with it the mother’s weight and the load on her body also grows. But this does not mean that edema during pregnancy does not need to be dealt with: first of all, with edema, the blood flow through which oxygen and nutrients are supplied to the baby suffers.

Therefore, if for the mother puffiness is not very pleasant, tiring, a little painful, but still a condition with which one can come to terms, then for the baby it is actually a life of hand to mouth. In such conditions, he will not be able to develop normally.

Many medications during pregnancy are simply prohibited, and diuretics are no exception. That is why the best way out of the situation is to structure your diet in such a way that it necessarily includes diuretic foods.

Is it possible to lose weight on diuretics?

Products that have a diuretic effect are often used for weight loss. It would seem that nothing could be simpler: get rid of excess fluid - and enjoy the effect of losing weight. One thing: in this case, you will only have to enjoy the effect, and not the fact of losing weight. Excess fluid and excess fat are not the same thing.

After all, the main thing in the process of losing weight is to get rid of energy reserves that the body puts aside for a rainy day, and not from extra centimeters that may return very soon. That is why you should not rely on natural diuretics as a means for weight loss: for a long time to be proud of the effect that will produce more on others slim stomach and a slimmed waist, alas, will not succeed.

Diuretics from the garden: calling on nature to help

What foods and drinks are diuretics and have a diuretic effect?

You may be surprised, but the list of them will not be so short, and almost all of them, which is important, are allowed during pregnancy.

Vegetables

• Tomato;
  This amazing vegetable not only contains a lot of vitamins and nutrients, but also forces the kidneys to more active work, forcing them to push as much fluid through the body as possible.
• cucumber;
  Being alkaline in nature, cucumber neutralizes acid accumulated in the body and helps remove excess fluid.
• eggplant;
  One of the undoubted advantages of eggplant is its ability to cleanse bile ducts, as well as rid the body of edema.
• beet;
  By improving liver and kidney function, beets are considered one of the most powerful natural diuretics.
• Brussels sprouts;
  The substances contained in this vegetable help improve the functioning of the pancreas and kidneys, due to which excess fluid is expelled.

Fruits and berries

• Apricot, cherry;
  Rich in potassium, these fruits improve the functioning of the cardiovascular system, accelerate blood flow, and clear blockages from the kidney tubules. Thanks to this, the liquid begins to circulate faster through the body and is eliminated from it more quickly.
• watermelon;
  It consists almost entirely of liquid. Regular consumption of watermelon speeds up kidney function, while the body does not become dehydrated, but only gets rid of stagnant fluid.
• citrus fruits (oranges, lemons, grapefruits, kiwi);
  All these fruits contain loading dose vitamin C, thanks to which swelling disappears.
• strawberry;
  Lowers blood pressure and cholesterol levels, and also removes uric acid from the body. This is largely due to the removal of excess liquid.
• grape;
  The substances that grapes are rich in cleanse the system of veins, blood vessels and capillaries, remove toxins and excess acid, and with it the liquid and the body.
• cranberry;
  One of the most effective means in the fight against edema. It is noteworthy that it is cranberries in folk medicine treat urinary tract infections and kidney diseases.

Herbs

• ginger;
  Has long been known for its amazing properties. It perfectly cleanses the body of toxins, and the blood and lymphatic system- from blockages. Both fresh and dried ginger, and the juice obtained from it.
• salad;
  Green salad stimulates genitourinary system, cleanses the kidneys.
• parsley;
  Perfectly cleanses the kidneys of toxins.
• celery;
  Accelerates metabolism, harmonizes the functioning of the whole body, strengthens the walls of blood vessels.

Cereals

• buckwheat;
  Besides many the most useful properties Buckwheat also has the ability to remove fluid that accumulates in it from the body. This property is due to the content of a special substance in it - routine. By the way, if you need to get rid of swelling that bothers you quickly and without consequences for the body, use only one for two to three days. buckwheat porridge, cooked in water, without any additives. The amount of water per day is no more than one and a half liters. Such buckwheat diet will help you quickly cope with swelling and, by the way, can be used as one of the tools for losing weight;
• oats;
  This cereal normalizes metabolism, cleanses the body of waste and toxins, and removes internal inflammation. A decoction of oat grains is well known to healers as an excellent diuretic.

Beverages

Many drinks have a diuretic effect. In first place are, of course, tea and coffee, which contain caffeine. It is what binds and removes excess fluid from the body.

Juices from them also have the same effect as the above-mentioned vegetables and fruits. A glass of citrus juice or a cucumber-green smoothie is a much healthier alternative to medicinal diuretics.

But you can make compote from fruits and berries. This drink will not only get rid of excess fluid, but will also cool the body during the hot season.

Whatever diuretic foods and drinks you choose to help with edema during pregnancy or for weight loss, it is important to remember: you cannot use them too often. Together with the liquid, they wash away beneficial substances from the body. Be moderate and prudent: it won’t harm your health in any way!

This group of drugs includes drugs of various chemical structures that inhibit the reabsorption of water and salts in the kidney tubules and increase their excretion in the urine.

Drugs that increase the rate of urine formation are used for cardiac edema (chronic heart failure, CHF), renal and hepatic edema. With all these forms of pathology (especially with CHF), the patient has a positive sodium balance (that is, the amount of sodium taken with food exceeds its excretion). The removal of sodium from the body is accompanied by a decrease in edema. That's why highest value have those diuretics that increase, first of all, natriuresis.

In the formation of urine main role three processes play:

1) filtration;

2) reabsorption;

3) tubular secretion.

These processes are determined by the peculiarities of the morpho-functional organization of the kidney. It is known that the medulla of the kidney consists of nephrons, which have in their structure a vascular glomerulus located in the Shumlyansky-Bowman capsule, where filtration of blood plasma occurs and the formation of primary urine, devoid of high molecular weight proteins and other compounds. Normal daily glomerular filtrate is about 150 liters and contains approximately 1.2 kg of sodium.

Filtration is a passive process; is provided by the pumping function of the heart, the oncotic pressure of the undifferentiated part of the plasma, as well as the number of functioning glomeruli.

Primary urine enters the second section - the tubules, which are divided into proximal, distal sections and the loop of Henley. In the tubules, the process of reabsorption (that is, reverse absorption) into the blood of water, sodium ions, potassium, chlorine, bicarbonate, etc. occurs. Also in this area, amino acids, vitamins, glucose, proteins, and trace elements are completely reabsorbed. This process occurs with the participation of a number of enzymes (carbonic anhydrase, etc.). Secretory processes are also observed in the tubules, as a result of which some metabolites and xenobiotics are released (for example, penicillin, etc.). As a result of reabsorption, secondary urine is formed and excreted from the body. healthy person in an amount of 1.5 liters and containing 0.005 kg of sodium per day.

Sodium reabsorption occurs predominantly in the distal tubules under the influence of the adrenal hormone aldosterone. If aldosterone levels increase, sodium and water retention occurs in the body (which happens with heart failure, liver diseases, etc.). The release of aldosterone is stimulated by angiotensin-II, and therefore one of the functions of the latter is the indirect retention of sodium, and therefore water, in the body.

In the distal sections of the tubules on the processes of reabsorption during

Antidiuretic hormone (ADH) or vasopressin (hormone of the posterior pituitary gland) also influences this. ADH, facilitating the reabsorption of water, reduces the volume of urine, increasing its osmolarity.

Atriopeptides or natriuretic factors have also been isolated, which are normally released in the atrial appendages when they are stretched too much by the blood and regulate water-sodium homeostasis.

All the main drugs of the diuretic group act on reabsorption processes and inhibit them, although tubular reabsorption of water is reduced by only 1%.

For use in clinical practice have important classifications dividing diuretics according to strength of action, speed of onset of effect and duration of action.

CLASSIFICATION OF DIURETICS

I. Potent or high-acting (“ceiling”) diuretics

Furosemide, ethacrynic acid;

II. Intermediate diuretics, benzothia derivatives

diazine (thiazide diuretics)

Dichlorothiazide, polythiazide;

III. Potassium-sparing diuretics

1) aldosterone antagonists:

Spironolactone (veroshpiron, "Gedeon Richter");

2) with an unknown mechanism of action:

Triamterene, amiloride.

In terms of potency, these are weak diuretics.

IV. Carbonic anhydrase inhibitors:

Diacarb.

This drug, as a diuretic, is also a weak diuretic.

All four of the above groups of agents primarily remove salts, primarily sodium and potassium, as well as chlorine anions, bicarbonates, and phosphates. That is why drugs from these four groups are called saluretics.

V Osmotic diuretics

Mannitol, urea, concentrated solutions of gluten

goats, glycerin.

These diuretics are taken into separate group, since they primarily remove water from the body.

The use of diuretics is intended to change the sodium balance in the body, making it negative. Only in this case will the increased excretion of sodium be accompanied by an increase in the excretion of water from the body and a decrease in edema.

The first group is “ceiling, high”, strong, powerful diuretics (High ceiling diuretics).

FUROSEMIDE (Furosemidum; in tablets of 0.04; 1% solution in amp. 2 ml) - is considered a loop diuretic, since the diuretic effect is associated with inhibition of the reabsorption of sodium and chloride ions throughout the loop of Henle, especially in its ascending section .

ETHACRINIC ACID (uregit; Acidum etacrinicum; Uregit; in the table 0.05; 0.1).

Drugs in this group inhibit sodium reabsorption by 10-20%, therefore they are powerful, short-acting diuretics. Pharmacological effect Both drugs are almost the same. The mechanism of action of furosemide is associated with the fact that it significantly increases renal blood flow (by increasing the synthesis of prostaglandins in the kidneys). In addition, this drug inhibits energy production processes (oxidative phosphorylation and glycolysis) in the kidneys, which are essential for the reabsorption of ions. Furosemide moderately (twice) increases the urinary excretion of potassium and bicarbonate ions, mostly calcium and magnesium, but reduces the excretion of uric acid. In addition to the diuretic effect, furosemide has the following actions, due to both a direct effect on all smooth muscles of the vascular wall and a decrease in sodium content in them, which ultimately reduces the sensitivity of myocytes to catecholamines:

1. Direct pacemaker;

2. Antiarrhythmic;

3. Vasodilator;

4. Contrinsular.

When taken orally, the effect occurs within an hour, and the duration of action is 4-8 hours. At intravenous administration the diuretic effect occurs within 3-5 minutes (IM after 10-15 minutes), reaching a maximum after 30 minutes. In general, the effect lasts about 1.5-3 hours.

Side effects.

One of the most common adverse reactions is hypokalemia, which is accompanied by weakness of all muscles, anorexia, constipation and heart rhythm disturbances. This is also facilitated by the development of hypochloremic alkalosis, although this effect special significance does not, since the effect of these drugs does not depend on the reaction of the environment.

Basic principles of combating hypokalemia:

Intermittent administration of diuretics that cause

loss of potassium;

Combining them with potassium-sparing diuretics;

Limiting sodium in food;

Enrichment by rich in potassium diets (raisins, dried apricots, pe

boiled potatoes, bananas);

Prescription of potassium preparations (asparkam, panangin).

Drugs in this group also inhibit the secretion of uric acid, thereby causing hyperuricemia. This is especially important to consider in patients suffering from gout.

In addition to hyperuricemia, drugs can cause hyperglycemia and exacerbation of diabetes mellitus. This effect is most likely in patients with latent and manifest types of diabetes.

By increasing the concentration of atrium in the endolymph of the inner ear, these drugs cause an ototoxic effect (hearing damage). Moreover, if the use of furosemide causes reversible changes, then the use of uregitis, as a rule, is accompanied by irreversible disorders of the hearing aid.

It should also be said that it is impossible to combine furosemide and ethacrynic acid with nephro- and ototoxic antibiotics (ceporin, cephaloridine - first generation cephalosporins), aminoglycoside antibiotics (streptomycin, kanamycin, etc.), which also have a damaging side effect on the hearing organ.

When using drugs internally, minor, mild dyspeptic disorders are observed.

Possible upon admission skin rashes, decrease in the number of red blood cells, white blood cells, damage to the liver, pancreas. In experiments, drugs sometimes have a teratogenic effect.

Indications for use:

In tablets:

1. For chronic edema caused by chronic

heart failure, liver cirrhosis, chronic

chelic nephritis;

2. As drugs of choice for heart failure with

severe hemodynamic disorders;

3. B complex therapy patients with hypertension

In solution (iv):

1. In case of acute edema of the brain and lungs (dehydration

rapia, removal of water from tissues);

2. If forced diuresis is necessary

(for acute drug poisoning and poisoning

others chemicals that stand out

mainly with urine);

3. Hypercalcemia of various origins;

4. In case of hypertensive crisis;

5. For acute heart failure.

The dose of furosemide, as well as any other diuretic, is considered correctly selected when for a given patient diuresis during the period active therapy increases to 1.5-2 liters/day.

Ethacrynic acid has the same indications for use as furosemide, except hypertension, as it is not suitable for long-term use.

Contraindications to the use of powerful diuretics:

Hypovolemia, severe anemia, renal and hepatic

failure.

Potent but short-acting drugs also include torasemide, bumetanide, and piretanide.

Moderate strength diuretics (benzothiadiazine derivatives or thiazide diuretics)

A typical representative is DICHLOTHIAZIDE (Dichlothiazidum; in tablets 0.025 and 0.100). Well absorbed from the gastrointestinal tract. Diuretic effect develops after 30-60 minutes, reaches a maximum after two hours and lasts 10-12 hours.

Drugs in this group reduce the active reabsorption of chlorine, respectively, the passive reabsorption of sodium and water in a wide part of the ascending part of the loop of Henle.

The mechanism of action of the drug is associated with a decrease in energy supply to the process of chlorine transfer through the basement membrane. In addition, thiazide diuretics moderately inhibit carbonic anhydrase activity, which also increases natriuresis. Chloruresis under the influence this drug is carried out in an amount equivalent to natriuresis (that is, chloruresis also increases by 5-8%). When using the drug, there is a moderate loss of bicarbonate anion and magnesium, but an increase in calcium ions and uric acid in the blood plasma.

Among all diuretics, thiazides have the most pronounced kaliuretic effect; Meanwhile, thiazides also have the most pronounced antihypertensive effect, which is explained by the diuretic effect (decrease in blood volume), as well as a decrease in sodium content in vascular wall, which reduces vasoconstrictive reactions biologically active substances. Dichlorothiazide also potentiates the action antihypertensive drugs, used simultaneously with it.

This drug reduces diuresis and thirst in diabetes insipidus, while reducing the increased osmotic pressure of blood plasma.

Advantages of thiazide diuretics:

1. sufficient activity of action;

2. act quickly enough (within 1 hour);

3. act for quite a long time (up to 10-12 hours);

4. do not call pronounced changes in acid-base

condition.

Disadvantages of thiazide diuretics:

1. Since drugs in this group act predominantly

in the distal tubules, they are more likely to cause

hypokalemia. For the same reason, hypomagnesium develops

emia, and magnesium ions are necessary for potassium intake

inside the cell.

2. The use of thiazides leads to a delay in the body with

uric acid leakage, which can provoke arthralgia

in a patient with gout.

3. Drugs increase blood sugar levels, which causes pain

diabetes mellitus can lead to exacerbation of problems

4. Dyspeptic disorders(nausea, vomiting, diarrhea,

weakness).

5. Rare, but dangerous complication- development of pancreatitis,

CNS lesions.

Indications for use:

1. Most widely used for chronic edema,

associated with chronic heart failure, pa

tology of the liver (cirrhosis), kidneys (nephrotic syndrome

2. When complex treatment patients with hypertension

3. For glaucoma.

4. When Not diabetes mellitus(paradoxical effect, mechanism

which is not clear, but the BCC decreases, therefore,

feeling of thirst).

5. For idiopathic calciuria and oxalate stones.

6. For edematous syndrome of newborns.

The drugs CLOPAMIDE (BRINALDIX) and OXODOLINE (HYGROTON), as well as INDAPAMIDE and CHLORTALIDONE, are similar in activity to thiazides, but superior to them in duration of action.

POTASSIUM SPARING DIURETICS

SPIRONOLACTONE (veroshpiron; Spironolactonum, Verospironum, Gedeon Richter, Hungary; tablets 0.025) is a weak potassium-sparing diuretic that is a competitive antagonist of aldosterone. Spironolactone by chemical structure is very similar to aldosterone (steroid), and therefore blocks aldosterone receptors in the distal tubules of the nephron, which interferes with the return flow (reabsorption) of sodium into the cell renal epithelium and increases urinary excretion of sodium and water. This diuretic effect develops slowly - after 2-5 days and is rather weakly expressed. The inhibition of reabsorption of sodium filtered in the glomeruli is no more than 3%. At the same time, inhibition of kaliuresis manifests itself immediately after administration of the drug. The activity of spironolactone is independent of the acid-base state. The drug has a significant duration of action (up to several days). This is a slow but long acting. The drug increases calciuresis and has a direct positive inotropic effect on the heart muscle.

Indications for use:

1. Primary hyperaldosteronism(Conn syndrome - tumor

adrenal glands). For this pathology, veroshpiron is used

ut as a drug of conservative therapy.

2. With secondary hyperaldosteronism developing with

chronic heart failure, liver cirrhosis,

nephropathic syndrome.

3. In complex therapy of patients with hypertension.

4. Spironolactone is indicated for combining it with other

diuretics that cause hypokalemia, that is, for core

correction of potassium balance disturbed during use

other diuretics (thiazides, diacarb).

5. The drug is prescribed for gout and diabetes.

6. Spironolactone is also prescribed to enhance cardiotonia

ical action of cardiac glycosides (here also va

(not to mention the fact that spironolactone inhibits kaliuresis).

Side effects:

1. Dyspeptic disorders (abdominal pain, diarrhea).

2. With long-term use in conjunction with medications

potassium - hyperkalemia.

3. Drowsiness, headaches, skin rashes.

4. Hormonal disorders(the drug has a steroid

structure): - in men - gynecomastia may occur;

In women - virilization and menstrual irregularities

5. Thrombocytopenia.

A drug of the same group is TRIAMTEREN (pterophen). Available in 50 mg capsules. Weak potassium-sparing diuretic, onset of action after 2-4 hours, duration of effect - 7-16 hours. It disrupts the reabsorption of sodium in the collecting ducts and inhibits kaliuresis (distal sections). The drug enhances the effect of other diuretics, especially thiazides, preventing the development of hypokalemia. Promotes the removal of urates. It has a hypotensive effect of sufficient strength. The drug should not be prescribed to pregnant women, as reductase, an enzyme that translates folic acid into folinium.

A potassium-sparing diuretic of weak strength with an average duration of action is also the drug AMILORIDE (5 mg tablets). The drug TRIAMPUR is a combination of triamterene and dichlorothiazide.

DRUGS - CARBONAN HYDRASE (CAH) INHIBITORS

DIACARB (Diacarbum; fonurit, diamox; in powders and tablets of 0, 25 or in ampoules of 125, 250, 500 mg). The drug is a diuretic average speed and duration of action (the effect occurs after 1-3 hours and lasts about 10 hours, with intravenous administration - after 30-60 minutes, for 3-4 hours).

The drug inhibits the enzyme carbonic anhydrase, which normally promotes the connection in nephrocytes carbon dioxide and water with the formation of carbonic acid. The acid dissociates into a hydrogen proton and a bicarbonate anion, which enters the blood, and a hydrogen proton into the lumen of the tubules, exchanging for a reabsorbed sodium ion, which, together with the bicarbonate anion, replenishes the alkaline reserve of the blood.

A decrease in CAG activity when using Diacarb occurs in proximal parts nephron, which leads to a decrease in the formation of carbonic acid tubules in the cells. This causes a decrease in the flow of bicarbonate anion into the blood, which serves to replenish the alkaline reserve of the blood, and the flow of hydrogen ion into the urine, exchanging for sodium ion. As a result, sodium excretion in urine in the form of bicarbonates increases; Chlorine reabsorption changes little. The latter, combined with a decrease in the formation and entry into the blood of bicarbonate anion, leads to the development of hyperchloremic acidosis. There is a compensatory increase in kaliuresis, which leads to hypokalemia.

Reduction of CAG activity by diacarb in endothelial cells and choroid plexus cells leads to decreased secretion and improved outflow cerebrospinal fluid, which helps reduce intracranial pressure. Diacarb reduces production intraocular fluid and reduces intraocular pressure, especially significant in patients with an acute attack of glaucoma.

The exchange of sodium for potassium leads to the fact that this diuretic, being a relatively weak diuretic (inhibition of sodium reabsorption by no more than 3%), causes severe hypokalemia. In addition, due to the fact that sodium bicarbonate does not return to the blood to replenish alkaline reserves, severe acidosis develops, and under conditions of acidosis, the effect of diacarb ceases. Thus, we can conclude that diacarb is rarely used as a diuretic.

Indications for use:

1. In the treatment of patients with an acute attack of glaucoma (possible intravenously). 2. Traumatic brain injury with increased intracranial pressure

3. For some forms of minor attacks of epilepsy. 4. In combination with loop diuretics for prophylaxis or

elimination of metabolic alkalosis. 5. In case of poisoning with salicylates or barbiturates to increase

diuresis and urine alkalinity.

6. With a significant increase in uric acid content in

blood with the threat of its precipitation in leukemia, treatment

cytostatics.

7. To prevent altitude sickness.

Diakarb is prescribed 0.25 - 1 tablet per 1 dose per day daily for 3 - 4 days, followed by a break for 2-3

days, then such courses are repeated for 2-3 weeks.

OSMOTIC DIURETICS

This group of diuretics includes mannitol, concentrated glucose solutions, and glycerin. These drugs are combined into one group general mechanisms actions. The latter determine that the diuretic effect of these diuretics is strong and powerful.

MANNITOL (MANNITOL; Mannitolum) is a hexahydric alcohol, which is the most powerful of the existing osmotic diuretics. It is able to increase diuresis by 20% of all sodium filtered in the glomeruli.

Available in hermetically sealed 500 ml bottles containing 30.0 of the drug, as well as in ampoules of 200, 400, 500 ml of 15% solution.

It comes out slowly. When administered intravenously, while in the blood, mannitol, like other diuretics of this group, sharply increases the osmotic pressure in the blood plasma, which leads to an influx of fluid from the tissues into the blood and an increase in blood volume ("drying effect"). This leads to a decrease in the reabsorption of sodium and water in the distal part of the nephron, and also causes increased filtration in the glomeruli. In addition, mannitol is well filtered through the glomerular membrane and creates high osmotic pressure in the urine, and is not reabsorbed in the tubules. Mannitol does not undergo biotransformation and is excreted unchanged, and therefore constantly attracts water and primarily removes it with itself. The use of osmotic diuretics is not accompanied by hypokalemia and changes in acid-base status.

In terms of its ability to remove water from the body, mannitol is almost the most powerful drug.

Indications for use:

1. Prevention of development or elimination of cerebral edema

(shock, brain tumor, abscess) is the most common

extended indication.

2. Mannitol is indicated as a means of dehydration therapy

with pulmonary edema that occurs after a toxic effect

gasoline, turpentine, formaldehyde on them; and also for swelling

3. When carrying out forced diuresis, in particular when

poisoning with drugs (barbiturates,

salicylates, sulfonamides, PAS, boric acid),

when transfusion of incompatible blood.

4. When acute attack glaucoma.

5. To reduce damage to the kidney tubules during sudden

decrease in filtration (in patients with shocks, burns,

sepsis, peritonitis, osteomyelitis, in which

improves renal blood flow), in case of severe poisoning

hemolytic poisons (precipitation of proteins,

hemoglobin - danger of blockage renal tubules And

development of anuria).

Side effects:

Headache, nausea, vomiting, sometimes allergic reactions

Diuretic foods - vegetables, fruits, berries and other fruits - will help remove excess fluid and replenish the body with useful substances. Proper diet in combination with diuretics - the most effective method get rid of swelling and excess weight, cleanse the body of salts and toxins and prevent the development of gallstone and urolithiasis.

To improve the condition of a person with diseased kidneys, it would be appropriate to introduce diuretic products into the diet.

When are natural diuretics needed?

If a person has excessive swelling of the limbs or the whole body, doctors recommend consuming natural diuretics - foods. They are useful for renal or heart failure, diabetes mellitus, overweight or cellulite. In addition, such food has a positive effect on the body when physical activity, replacing medications. Doctors also recommend using diuretics for women during the premenstrual period.

Products with diuretic properties effectively relieve swelling during pregnancy and are safe for expectant mothers.

Rules of application

To achieve the desired result, diuretic food must be present in a person’s diet every day. Due to their diversity, such products can be consumed at any time of the year. For maximum effect, you should follow a diet excluding spicy or salty foods, which slow down the removal of fluid from the body. Freshly squeezed juices will help consolidate the results. It is not recommended to consume foods with diuretic properties at night: this can lead to insomnia.

List of the most diuretic foods

Among the cereals that have a diuretic effect, buckwheat and oatmeal should be highlighted. Buckwheat regulates metabolism, supports kidney and heart function, and also reduces weight. Oatmeal rids the body of excess fluid, cleanses the liver and kidneys, and maintains cholesterol and blood sugar levels. In addition, oats have diuretic properties: they affect the metabolism in the body and speed up digestion. Barley removes toxins from the body and slows down the aging process. It is recommended to consume porridge without salt and additive sauces.

Diuretic vegetables

Natural products can remove from the body excess liquid and salt, while preserving nutrients. The list of vegetables that have the maximum diuretic effect includes:

• cucumbers are the best diuretics, more than 90% consist of liquid;
• artichokes - stimulate the secretion of bile;
• celery - improves water-salt metabolism, slows down the aging process;
• tomatoes - regulate water balance, improve skin condition;
• beets - effectively removes excess moisture, but doctors do not recommend consuming this vegetable if there are kidney stones;
• cabbage - stimulates the digestive system.

Fruits for swelling

Fruit fruits - natural springs vitamins and microelements necessary for a person. The most effective diuretic fruits:

All fruits have a diuretic effect, but to varying degrees.

• melon and watermelon - natural remedy for the treatment of cholelithiasis and urolithiasis;
• apples - normalize work gastrointestinal tract, liver and kidneys;
• bananas - promote weight loss and normalize blood pressure;
• quince - useful for people with heart disease vascular system;
• peach - 80-90% consists of liquid, is well digestible and improves the functioning of the digestive system;
• grapefruit - causes weight loss and lowers cholesterol levels in the blood;
• tangerine - restores intestinal microflora;
• pear - regulates intestinal function, normalizes heart function, helps reduce temperature;
• pomelo - effectively breaks down proteins and fats, regulates blood pressure;
• persimmon - has high content sodium, manganese, magnesium, calcium, potassium and iron;
• nectarine - accelerates metabolism in the body, prevents the appearance of kidney stones.

Diuretic drugs specifically affect kidney function and speed up the process of excretion of urine from the body.

The mechanism of action of most diuretics, especially if they are potassium-sparing diuretics, is based on the ability to suppress the reabsorption of electrolytes in the kidneys, more precisely in the renal tubules.

An increase in the amount of released electrolytes occurs simultaneously with the release of a certain volume of liquid.

The first diuretic appeared in the 19th century, when a mercury drug was discovered, widely used to treat syphilis. But the drug did not show effectiveness against this disease, but its strong diuretic effect was noticed.

After some time, the mercury drug was replaced with a less toxic substance.

Soon, modification of the structure of diuretics led to the formation of very powerful diuretics medicines, which have their own classification.

Why are diuretics needed?

Diuretic drugs are most often used to:

• with cardiovascular failure;
• for swelling;
• ensure urine output in case of renal dysfunction;
• reduce high blood pressure;
• in case of poisoning, remove toxins.

It should be noted that diuretics work best for hypertension and heart failure.
High swelling can be a consequence of various heart diseases, pathologies of the urinary and vascular systems. These diseases are associated with sodium retention in the body. Drugs diuretic action withdraw excess accumulation this substance and thus reduce swelling.

With high blood pressure, excess sodium affects the muscle tone of blood vessels, which begin to narrow and contract. Used as antihypertensive drugs, diuretics flush sodium from the body and promote vasodilation, which in turn lowers blood pressure.

In case of poisoning, some of the toxins are eliminated by the kidneys. Diuretics are used to speed up this process. IN clinical medicine This method is called “forced diuresis.”

First, patients are given intravenously a large number of solutions, after which a highly effective diuretic is used, which instantly removes fluid from the body, and with it toxins.

Diuretics and their classification

For various diseases specific diuretics are prescribed that have different mechanism actions.

Classification:

1. Drugs that affect the functioning of the epithelium of the renal tubules, list: Triamterene Amiloride, Ethacrynic acid, Torasemide, Bumetamide, Flurosemide, Indapamide, Clopamide, Metolazone, Chlorthalidone, Methyclothiazide, Bendroflumethioside, Cyclomethiazide, Hydrochlorothiazide.
2. Osmotic diuretics: Monitol.
3. Potassium-sparing diuretics: Veroshpiron (Spironolactone) is a mineralocorticoid receptor antagonist.

Classification of diuretics according to the effectiveness of leaching sodium from the body:

• Ineffective - remove 5% sodium.
• Moderate effectiveness - remove 10% sodium.
• Highly effective - remove more than 15% of sodium.

Mechanism of action of diuretics

The mechanism of action of diuretics can be studied using the example of their pharmacodynamic effects. For example, a decrease in blood pressure is caused by two systems:

1. Reduced sodium concentration.
2. Direct effect on blood vessels.

Thus, arterial hypertension can be controlled by reducing fluid volume and long-term maintenance of vascular tone.

A decrease in the oxygen demand of the heart muscle when using diuretics is associated with:

• with relieving tension from myocardial cells;
• with improved microcirculation in the kidneys;
• with a decrease in platelet aggregation;
• with a decrease in the load on the left ventricle.

Some diuretics, for example, Mannitol, not only increase the amount of fluid excreted during edema, but are also capable of increasing the osmolar pressure of the interstitial fluid.

Diuretics, due to their properties to relax the smooth muscles of the arteries, bronchi, and bile ducts, have an antispasmodic effect.

Indications for prescribing diuretics

The basic indications for prescribing diuretics are arterial hypertension, most of all this applies to elderly patients. Diuretic drugs are prescribed for sodium retention in the body. These conditions include: ascites, chronic renal and heart failure.

For osteoporosis, the patient is prescribed thiazide diuretics. Potassium-sparing drugs are indicated for congenital syndrome Liddle (breeding huge amount potassium and sodium retention).

Loop diuretics have an effect on kidney function and are prescribed for high intraocular pressure, glaucoma, cardiac edema, and cirrhosis.

For the treatment and prevention of arterial hypertension, doctors prescribe thiazide drugs, which in small doses have a gentle effect on patients with moderate hypertension. It has been confirmed that thiazide diuretics in prophylactic doses can reduce the risk of stroke.

Taking these drugs in higher doses is not recommended, as this can lead to the development of hypokalemia.

To prevent this condition, thiazide diuretics can be combined with potassium-sparing diuretics.

When treating with diuretics, a distinction is made between active therapy and maintenance therapy. IN active phase moderate doses of potent diuretics (Furosemide) are indicated. During maintenance therapy - regular use diuretics.

Contraindications to the use of diuretics

In patients with decompensated liver cirrhosis and hypokalemia, the use of diuretics is contraindicated. Not prescribed loop diuretics patients who are intolerant to certain sulfonamide derivatives (diabetic and antibacterial drugs).

For people with respiratory and acute renal failure, diuretics are contraindicated. Diuretics of the thiazide group (Methyclothiazide, Bendroflumethioside, Cyclomethiazide, Hydrochlorothiazide) are contraindicated in type 2 diabetes mellitus, as the patient's blood glucose levels may rise sharply.

Ventricular arrhythmias are also relative contraindications to the prescription of diuretics.

For patients taking lithium salts and cardiac glycosides, loop diuretics are prescribed with great caution.

Osmotic diuretics are not prescribed for cardiac failure.

Side effects

Diuretics included in the thiazides list can lead to increased levels of uric acid in the blood. For this reason, patients diagnosed with gout may experience worsening of the condition.

Thiazide diuretics (Hydrochlorothiazide, Hypothiazide) can lead to undesirable consequences. If the wrong dosage was chosen or the patient is intolerant, the following side effects may occur:

• headache;
• possible diarrhea;
• nausea;
• weakness;
• dry mouth;
• drowsiness.

An imbalance of ions entails:

1. decreased libido in men;
2. allergies;
3. increase in blood sugar concentration;
4. spasms in skeletal muscles;
5. muscle weakness;
6. arrhythmia.

Side effects from Furosemide:

• decreased levels of potassium, magnesium, calcium;
• dizziness;
• nausea;
• dry mouth;
• frequent urination.

When ion exchange changes, the level of uric acid, glucose, and calcium increases, which entails:

• paresthesia;
• skin rashes;
• hearing loss.

TO side effects Aldosterone antagonists include:

1. skin rashes;
2. gynecomastia;
3. convulsions;
4. headache;
5. diarrhea, vomiting.

In women with incorrect prescription and incorrect dosage, the following are observed:

• hirsutism;
• menstruation disorder.

Popular diuretics and their mechanism of action on the body

Diuretics, which affect the activity of the renal tubules, prevent sodium from reentering the body and remove the element along with urine. Moderately effective diuretics Methyclothiazide Bendroflumethioside and Cyclomethiazide complicate the absorption of chlorine, not just sodium. Because of this action, they are also called saluretics, which means “salt.”

Thiazide-like diuretics (hypothiazide) are mainly prescribed for edema, kidney disease or heart failure. Hypothiazide is especially popular as an antihypertensive drug.

The medicine removes excess sodium and reduces pressure in the arteries. In addition, thiazide drugs enhance the effect of medications whose mechanism of action is aimed at lowering blood pressure.

When prescribing an increased dose of these drugs, fluid excretion may increase without lowering blood pressure. Hypothiazide is also prescribed for diabetes insipidus and urolithiasis.

The active substances contained in the drug reduce the concentration of calcium ions and prevent the formation of salts in the kidneys.

The most effective diuretics include Furosemide (Lasix). When this drug is administered intravenously, the effect is observed within 10 minutes. The drug is relevant for;

• acute failure of the left ventricle of the heart, accompanied by pulmonary edema;
• peripheral edema;
• arterial hypertension;
• removing toxins.

Ethacrynic acid (Uregit) is similar in action to Lasix, but lasts a little longer.

The most common diuretic, Monitol, is administered intravenously. The drug increases plasma osmotic pressure and lowers intracranial and intraocular pressure. Therefore, the drug is very effective for oliguria, which is the cause of a burn, injury or acute blood loss.

Aldosterone antagonists (Aldactone, Veroshpiron) prevent the absorption of sodium ions and inhibit the secretion of magnesium and potassium ions. Drugs in this group are indicated for edema, hypertension and stagnation heart failure. Potassium-sparing diuretics practically do not penetrate membranes.

Diuretics and type 2 diabetes

Note! It must be borne in mind that only some diuretics can be used, that is, prescribing diuretics without taking this disease into account or self-medication can lead to irreversible consequences in the body.

Thiazide diuretics for type 2 diabetes mellitus are prescribed mainly to lower blood pressure, for edema and for the treatment of cardiovascular failure.

Also for the treatment of most patients with arterial hypertension, lasting for a long time, thiazide diuretics are used.

These drugs significantly reduce the sensitivity of cells to the hormone insulin, which leads to increased levels of glucose, triglycerides and cholesterol in the blood. This imposes significant restrictions on the use of these diuretics in type 2 diabetes mellitus.

However, the latest clinical researches the use of diuretics in type 2 diabetes mellitus has proven that such Negative consequences most often observed with high doses of the drug. At low doses there are practically no side effects.