Key result
A diuretic pause, dietary salt restriction, and conventional furosemide with distally active diuretics induced a prompt weight loss exceeding 30 kg in a patient with refractory oedema and CHF.
Case Report (n=1)
In patients with CHF and refractory oedema, a diuretic pause and salt restriction followed by combination diuretic therapy can induce massive weight loss, suggesting oedema may be exacerbated by inappropriate loop diuretic therapy and high sodium intake.
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Offers hypothesis for managing refractory edema via diuretic pause; should not change practice pending controlled studies.
We report a patient with congestive heart failure (CHF) who presented with massive oedema resistant to therapy with maximal doses of loop diuretics, despite an adequate renal function. After a diuretic pause and dietary salt restriction, a conventional dose of furosemide in combination with distally active diuretics induced a prompt weight loss exceeding 30 kg with stable renal function. We suggest that the 'refractory' oedema in this patient was due to a combination of CHF and inappropriate (loop) diuretic therapy in conjunction with a high dietary sodium intake. We conclude that in the absence of hyponatremia and renal failure, even severe oedema may not represent a negative prognostic indicator. The recognition of diuretic-associated mechanisms complicating cardiac oedema is essential to avoid the vicious circle of worsening oedema whilst escalating therapy with loop diuretics.
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Haller et al. (1995) conducted a case report in congestive heart failure (n=1). Diuretic pause, dietary salt restriction, and conventional dose of furosemide with distally active diuretics vs. maximal doses of loop diuretics was evaluated on weight loss. A diuretic pause, dietary salt restriction, and conventional furosemide with distally active diuretics induced a prompt weight loss exceeding 30 kg in a patient with refractory oedema and CHF.
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