3 Situations to be Careful if Taking Diuretics

Taking diuretics has become one of the cornerstones of the treatment of hypertension and heart failure. Although it has benefits, it has risks too. Here are 3 situations that any person taking diuretics has to be watchful for.

People usually follow the doctor’s recommendations and take the diuretics faithfully once, twice or thrice a day. However, if the person taking the diuretics develops, diarrhea, vomiting or loses its appetite, he or she runs the risk of developing low blood pressure for volume loss in the vascular system. This can cause dizziness, syncope (passing out) or kidney failure.

Diuretics always carry the side effect of losing potassium and/or magnesium though the increased urine production. The best way to avoid this is to have a balanced diet or to take supplements. Low potassium or magnesium can cause dangerous cardiac arrhythmias or muscle weakness.

A low sodium concentration in the blood is also a potential consequence of the use of diuretics. This can happen if the person taking this type of medication drinks too much water while replacing the losses through the urine. Low sodium concentration in the blood can cause headaches, loss of balance, and if severe, lethargy, seizures and death. All diuretics can be associated with low sodium concentrations, however, the thiazide type of  diuretics are more commonly  related to this problem.

All medications cause side effects. Always talk with your doctor regarding these when starting a new one.

Marco A. Ramos MD

How to Correctly Rehydrate a Person

How to Correctly Rehydrate a Person

Dehydration can occur due to many reasons. The most common reasons to become dehydrated are vomiting, diarrhea and lack of oral intake. Doctors prefer to use the term “intravascular volume depletion”, however, it sounds too long and complicated. For the sake of simplicity I will consider “dehydration” and “intravascular volume depletion” equivalent terms.

Many people believe that drinking water or beverages like juices or tea are good to rehydrate a dehydrated person. The problem is that when someone becomes dehydrated he or she loses salts together with water. The content of salts in the above mentioned solutions is minimal. As a consequence of that, the body loses salts and water and gets back water. The sodium (the main electrolyte in the extracellular fluid) becomes diluted. Too much sodium dilution can cause problems like headaches and lack of balance. Severe sodium dilution can cause seizures and death.

In addition to what I have just mentioned, when the body is dehydrated, there is a hormone called anti-diuretic hormone (ADH) which is secreted. This hormone does not allow water to leave the body. This can have the effect of diluting further the sodium in the body. This is why, we need the right amount of salts when rehydrating.

There are over the counter solutions available can can help with the rehydration process. A good salty broth can also do the trick. However, if the dehydration is severe and vomiting does not allow proper oral rehydration, you might need to go to the closest emergency department before there is kidney failure or before you collapse

Marco A. Ramos MD

The Many Functions of the Kidney

The kidney has many vital functions. They can be altered by disease, trauma, medications or intoxications. Although the kidney is widely recognized as the organ which “makes urine” and in the process “cleaning the body from unnecessary substances”, it has many other functions.

The kidney regulates the level of fluid the body has. This function is closely tied with the regulation of the sodium and water contents of the body and with the blood pressure control. If this property fails, the could be high blood pressure, low blood pressure, high sodium or low sodium levels in the blood.

The body is alive because it can keep a tightly regulated pH (or acid-base status). If the blood pH drops below 6.8 or goes higher than 7.6 life is not sustainable. The kidney (together with the lung) is key in the control of the blood acid-base status.

The body needs a sensor to be able to create more red blood cells when they are needed. This sensor is the kidney. There is a hormone called erythropoietin which is secreted when there are less red blood cells or when the blood carries less oxygen.

The bone metabolism needs the kidney to produce activated vitamin D. This hormone is essential for the absorption of calcium from the intestine and to suppress another hormone called PTH, which if not suppressed it can lead to loss of bone mass and loss of phosphorus though the urine.

The body needs to keep a tight control of the potassium concentration in the extracellular fluid. The kidney is in charge to determine how much potassium should be allowed in the urine and how much should be retained.

The kidney has to be able to filtrate certain substances and to keep others. If the kidney were to let all substances be filtered, we would lose important proteins such as albumin and immunoglobulins (antibodies) though the urine.

By doing this quick summary, it is obvious that the kidney is a complex organ. The available forms of dialysis do a good job trying to mimic the function of the kidney, however, they are far away from perfect. The proof of this is how much better the results of kidney transplantation are compared to the results of dialysis.

Marco A. Ramos MD