#Cardiology_46 #Heart_failure_13 مريض ال HF لو كان عنده fluid | Clinical Medicine

#Cardiology_46 #Heart_failure_13
مريض ال HF لو كان عنده fluid Overload و Congestion بهلحالة بينضافله Diuretics ك Adjuvant مع علاجاته الأساسية

use diuretics in patients with heart failure with reduced ejection fraction and evidence of fluid retention

افضل نوع بنستخدمه من ال Diuretic هو ال Loop Diuretic

furosemide (Lasix) 20-40 mg orally once or twice daily initially, maximum 600 mg/day

bumetanide (Bumex) 0.5-1 mg orally once or twice daily initially, maximum 10 mg/day

Torsemide (Demadex) 10-20 mg orally once daily initially, maximum 200 mg/day

وأحيانا بنعطي Thiazide Diuretic زي مثلا

لو كان مريض HF و HTN وعنده Mild Fluid Retention
فال Thiazide بيكون كافي
لو كان المريض ماشي ع Loop diuretic ولسه ما وصل لل Response المطلوب فبنضيفله Thiazide diuretic مع ال loop
وبنسمي هلحالة sequential nephron blockade إني اعطي اتنين من ال diuretic يكون بيختلفو عن بعض بالميكانزم عشان نمنع ال
Diuretic Resistance

Metolazone :2.5 mg orally once daily initially, (maximum 20 mg/day)

sequential nephron blockade: 2.5-10 mg orally once daily plus loop diuretic

Hydrochlorothiazide : 25 mg orally once or twice daily initially,(maximum 200 mg/day)

sequential nephron blockade: 25-100 mg once or twice daily plus loop diuretic

Chlorthalidone :12.5-25 mg orally once daily initially, maximum 100 mg/day

Indapamide : 2.5 mg orally once daily initially, maximum 5 mg/day

Chlorothiazide : 250-500 mg orally once or twice daily initially, maximum 1,000 mg/day

sequential nephron blockade :500-1000 mg once plus loop diuretic



potassium-sparing diuretics may be useful in patients with fluid overload and hypokalemia

Amiloride (Midamor) 5 mg orally once daily initially, maximum 20 mg/day

Triamterene (Dyrenium) 50-75 mg orally twice daily initially, maximum 200 mg/day
هيك بنكون خلصنا ال HFrEF
هنبدأ ان شاء الله بال Acute HF
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