Usefulness of acetazolamide in the management of diuretic resistance

Worsening symptoms and fluid overload are the hallmarks of heart failure (HF) decompensation, and fluid removal is central to improvement. Despite high-dose loop diuretics, patients with decompensated HF may develop suboptimal diuresis/diuretic resistance. Sequential nephron blockade with a combinat...

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Bibliographic Details
Published in:Proceedings - Baylor University. Medical Center 2021, Vol.34 (1), p.169-171
Main Authors: Gill, Dalvir, Gadela, Naga Vaishnavi, Azmeen, Ayesha, Jaiswal, Abhishek
Format: Article
Language:English
Subjects:
Case Report
Case Studies
Diuretics
Heart failure
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Summary:Worsening symptoms and fluid overload are the hallmarks of heart failure (HF) decompensation, and fluid removal is central to improvement. Despite high-dose loop diuretics, patients with decompensated HF may develop suboptimal diuresis/diuretic resistance. Sequential nephron blockade with a combination of loop and thiazide/thiazide-like diuretics may be insufficient, resulting in poor outcomes. We present a case wherein urine output improved significantly with acetazolamide. Although the diuretic capacity of acetazolamide is weak on its own, it might be efficient in aiding the efficacy of loop diuretics. We discuss the pathophysiological basis and evidence behind its potential role in diuretic resistance. Drawing from current understanding, we propose a stepwise approach to diuresis in such patients.
ISSN:0899-8280
1525-3252
DOI:10.1080/08998280.2020.1830332