Effect of posture on the diuretic treatment of decompensated cirrhosis and heart failure

Q: Standing upright increases the responsiveness of diuretics.

A) True

B) False

Answer: B

On the contrary, the supine position increases diuretic responsiveness, particularly in congestive heart failure and cirrhotic patients.

Due to decreased ventricular function, cardiac output does not increase in heart failure patients while in an upright posture. Instead, kidney perfusion and urinary diuretic delivery are further diminished. The underlying phenomenon is also associated with clinically significant increases in plasma norepinephrine, renin, and aldosterone while upright.

A similar mechanism has been found in patients with сirrhоsis and ascites.

#cardiology

#pharmacology

References:

1. 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.

2. Minutolo R, Andreucci M, Balletta MM, Russo D. Effect of posture on sodium excretion and diuretic efficacy in nephrotic patients. Am J Kidney Dis. 2000 Oct;36(4):719-27. doi: 10.1053/ajkd.2000.17616. PMID: 11007673.

3. Wilken-Jensen C, Ring-Larsen H, Henriksen JH, Clausen J, Pals H, Christensen NJ. Betydningen af kroppens stilling for det diuretiske respons ved behandling af dekompenseret cirrose og morbus cordis [Effect of posture on the diuretic treatment of decompensated cirrhosis and heart failure]. Ugeskr Laeger. 1989 Jan 2;151(1):13-5. Danish. PMID: 2911877.