Combined Therapy with Thiazide-Type and Loop Diuretic Agents for Resistant Sodium Retention

Excerpt

True resistance to a loop-type diuretic agent such as furosemide is relatively uncommon, and treatment failures can often be attributed to noncompliance either with medication or diet (1). When patients have refractory edema due to nephrotic syndrome or hepatic cirrhosis, vigorous attempts to mobilize the excess fluid with diuretic agents are often inappropriate. Conversely, in patients with end-stage congestive heart failure or uncontrolled severe hypertension, sodium retention may be life threatening and warrant aggressive therapy. In the case of hypertension, the administration of a vasodilator or inhibitor of the sympathetic nervous system not only may contribute to the sodium retention