Thursday, March 8, 2018

Diuretics and patient's positioning

Q: Patients with congestive heart failure (CHF) respond to diuretics better in (select one)

A) upright position
B) supine position

Answer: B

Patients with CHF cannot increase cardiac output on an upright position. Renal perfusion diminishes and diuretic delivery to kidney diminishes. Also, as CHF patients fail to increase cardiac output on upright position, renal salt and water reabsorption increases with increase in norepinephrine, renin and aldosterone levels. Clinically this may be of significance in patients with acute exacerbation of CHF in ICU.



Ring-Larsen H, Henriksen JH, Wilken C, et al. Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture. Br Med J (Clin Res Ed) 1986; 292:1351.

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