Understanding pharmacokinetic and pharmacodynamic principles of diuretics is essential for managing diuretic resistance and severe congestion in heart failure.
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Case-based suggestions for diuretic-resistant HF congestion may guide select decisions; leaves open need for prospective validation.
We present the case of a patient with heart failure and severe congestion who was responding poorly to diuretic therapy. We discuss the key problems concerning the pathophysiology and bedside therapeutic approach to congestion and fluid overload in this clinical setting, and we give practical suggestions to overcome congestion, especially in the setting of diuretic resistance and worsening renal function. We conclude that the application of key pharmacokinetic and pharmacodynamic principles of diuretic therapy, along with in-depth knowledge of the pathophysiology of heart failure, still represent the cornerstones for a correct approach to decongestive therapy in these patients.
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Regolisti et al. (2016) studied this question.
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