Extreme Diuretic Dependence in Idiopathic Edema: Mechanisms, Prevention and Therapy

Abstract

Idiopathic edema patients abusing diuretics are occasionally becoming dependent to such a degree on increasing doses of diuretics that their withdrawal results in severe cardiorespiratory failure, occasionally even pulmonary edema. Two such patients are described and 1 is investigated in depth as to the mechanism of the diuretic abuse-induced excessive tubular avidity for sodium. An extreme diuretic-induced secondary hyperaldosteronism and atrial natriuretic factor suppression, although tapering off when diuretics are stopped, results in a continuous tubular sodium hyper-reabsorption. Since the most affected patient was deprived of the benefits of converting enzyme inhibitors because of their side effects, the only way to partially overcome this condition was a generous combination of several diuretics acting at several segments of the nephron. This contrasted with a similar patient who was relatively well controlled by a converting enzyme inhibitor combined with lower dose diuretics. Diuretic abuse-induced secondary hyperaldosteronism and diuretic resistance are apparently best prevented by converting enzyme inhibitors. When nonpharmacological preventive measures fail, converting enzyme inhibitors are preferable to diuretics as the first-choice treatment of idiopathic edema patients.

Idiopathic Edema: A Case Report

“…Diuretics have also been linked to idiopathic edema. Extended use of diuretics causes progressive resistance to and dependence on diuretics [10,11]. While our patient reported using diuretics for seven months, it is possible she had been using diuretics for longer than reported.…”

“…Abrupt withdrawal diuretic use can cause life-threatening conditions; therefore, a slow weaning method must be conducted. In addition to decreased diuretic dosage titration, the patient must also follow a low-salt diet and, when possible, recumbency [10].…”