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Do you know what to do when diuresis is not sufficient?",{"id":215,"name":216},1,"Course previews",[218,228,233],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},209,{"platform":223,"name":212,"url":224,"size":225},"YouTube","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=rHRv7UKEEfs",{"width":226,"height":227},200,113,{"type":229,"data":230},"free_text",{"readDurationInSeconds":231,"text":232},16.266666666666666,"\u003Cp>This is the final video in our free teaching series on diuretics. Do you know what to do when diuresis is not sufficient? Well, you definitely will after watching this video. It was taken from our brand-new Fluid and Electrolytes Masterclass!\u003C\u002Fp>\u003Cp>In case you missed the first four videos of this series, you can find them here:\u003Cbr>\u003Ca href=\"https:\u002F\u002Fpublic-nuxt.frontend.prod.medmastery.io\u002Fmagazine\u002Fphilosophy-diuretics\" target=\"_blank\">1. The philosophy of diuretics\u003C\u002Fa>\u003Cbr>\u003Ca href=\"https:\u002F\u002Fpublic-nuxt.frontend.prod.medmastery.io\u002Fmagazine\u002Floop-diuretics\" target=\"_blank\">2. Loop diuretics\u003C\u002Fa>\u003Cbr>\u003Ca href=\"https:\u002F\u002Fpublic-nuxt.frontend.prod.medmastery.io\u002Fmagazine\u002Fthiazide-diuretics\" target=\"_blank\">3. Thiazide diuretics\u003C\u002Fa>\u003Cbr>\u003Ca href=\"https:\u002F\u002Fpublic-nuxt.frontend.prod.medmastery.io\u002Fmagazine\u002Facetazolamide-and-potassium-sparing-diuretics\">4. Acetazolamide and the potassium-sparing diuretics\u003C\u002Fa>\u003C\u002Fp>",{"type":229,"data":234},{"readDurationInSeconds":235,"title":236,"text":237},90.13333333333333,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-5243c963-7fff-0545-3001-123b0d2b55b6\">[00:00:00]\u003C\u002Fb> Sometimes, diuretics don't have the effect that you expect. Here's an example of a good diuretic response. This diuretic failure has two typical patterns. So, the first is just you give the drug and you get no response. The other is that you give the drug and you just get a real short response, so that you don't get enough diuresis over 24 hours.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-5243c963-7fff-0545-3001-123b0d2b55b6\">[00:00:30] \u003C\u002Fb>So there are two different responses for this diuretic resistance. If you have a short response, you want to increase the frequency that you give the drug and that could overcome that short response. You can even use a continuous drip or switch your diuretic to a longer acting diuretic to overcome this. This is typical of the diuretic failure we see in heart failure, liver failure, and nephrotic syndrome and usually \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-5243c963-7fff-0545-3001-123b0d2b55b6\">[00:01:00] \u003C\u002Fb>increasing the frequency is your best bet there. The other pattern of diuretic response is no or minimal response. Here, increasing the frequency doesn't help. You just get the same crappy response more often. This pattern of resistance is usually due to decreased glomerular filtration rate, renal failure or significant proteinuria. It is thought that the proteinuria that gets into the tubular fluid\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-5243c963-7fff-0545-3001-123b0d2b55b6\">[00:01:30] \u003C\u002Fb>binds up the diuretics, they're so prone to being protein bound. The best response to this type of resistance is to increase the dose. By increasing the dose, you can overcome this decrease in GFR. What I found to be effective is increasing the furosemide to 20 times the serum creatinine to get an effective dose. The last pattern of diuretic resistance occurs when you get distal sodium reabsorption to \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-5243c963-7fff-0545-3001-123b0d2b55b6\">[00:02:00]\u003C\u002Fb> compensate for proximal diuretic. An example would be acetazolamide. Even if the acetazolamide is highly effective and increasing downstream sodium, the kidney has a number of different opportunities to increase its sodium reabsorption and prevent net diuresis. This is one of the primary reasons that acetazolamide is considered a weak diuretic. This also occurs after extended exposure to loop diuretic. Patients up-regulate distal sodium reabsorption. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-5243c963-7fff-0545-3001-123b0d2b55b6\">[00:02:30]\u003C\u002Fb> So, here's your loop diuretics, causes a lot of distal sodium delivery. The kidney responds by up-regulating sodium reabsorption. We can actually see hypertrophy of the distal convoluted tubule, on kidney biopsies, when they've been on loop diuretics. The response to this, to compensate for distal sodium reabsorption, is to block it with additional types of diuretics. So, here are the loop diuretics. There's the response with increased sodium reabsorption, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-5243c963-7fff-0545-3001-123b0d2b55b6\">[00:03:00] \u003C\u002Fb>and then we compensate by either adding thiazide-type diuretics, potassium-sparing diuretics or both.\u003C\u002Fp>",{"courses":239,"showAwardsBelow":48},[240],{"id":241,"isFreeCmeCourse":242,"title":243,"type":244,"specialization":245,"teachers":247,"cmeCredits":249,"teacherIllustration":250,"backgroundImage":251,"relativeUrl":252,"lastChanged":253,"created":254,"description":255,"relativeURL":252,"meta":256},2026,false,"Fluids and Electrolytes Masterclass","course",[246],"Nephrology",[248],"Joel Topf, MD",5,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eb7-10af-4c65-8174-3df202658892","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eb7-dae2-4c71-baf3-9333ed8f1a6b","\u002Fcourses\u002Ffluids-and-electrolytes-masterclass","1769957860","1414606544","If you are a clinician working in internal medicine, you are likely taking care of patients with fluid and electrolyte problems on a daily basis. This course teaches you the nuts and bolts of fluid and electrolyte management. You'll discover what it really means when sodium or potassium levels are abnormal, learn how to diagnose and treat imbalances, and get expert tips for prescribing diuretics.",{"duration":257,"quizzes":258,"lessons":259},12323,9,54,{"id":261,"name":248,"image":262,"profession":263,"relativeUrl":266,"specializations":267},2118,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefc-8e10-40f7-ba94-3b1be2090eaa",{"name":264,"description":265},"Nephrologist","Board certified nephrologist. Author of several medical textbooks. Social media aficionado.","\u002Fteachers\u002Fjoel-topf-md",[246],112,"2m",[271,299,318],{"id":272,"title":273,"text":274,"image":275,"author":283,"path":292,"readDuration":293,"readDurationFormatted":294,"internal":295},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":276,"title":277,"size":278,"location":280},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":279,"height":279},1200,{"bucket":281,"key":282},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":284,"title":285,"relativeURL":286,"image":287,"professionLong":288,"profession":289,"weight":291},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":290},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":296,"updated":297,"published":298},1778115738,1778799792,1778118255,{"id":300,"title":301,"text":302,"image":303,"author":309,"path":311,"readDuration":312,"readDurationFormatted":313,"internal":314},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":304,"title":277,"size":305,"location":307},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":306,"height":306},600,{"bucket":281,"key":308},"\u002F2026-04\u002FC121_magazine image.png",{"id":284,"title":285,"relativeURL":286,"image":287,"professionLong":288,"profession":310,"weight":291},{"name":290},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":315,"updated":316,"published":317},1777403036,1777572381,1777412421,{"id":319,"title":320,"text":321,"image":322,"author":327,"path":336,"readDuration":337,"readDurationFormatted":338,"internal":339},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":323,"title":277,"size":324,"location":325},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":306,"height":306},{"bucket":281,"key":326},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":328,"title":329,"relativeURL":330,"image":331,"professionLong":332,"profession":333,"weight":335},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":334},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":340,"updated":341,"published":342},1776705362,1776710540,1776710541,{"seo":344,"og":346},{"title":345,"description":213},"Diuretic resistance | Medmastery",{"title":345,"description":213,"image":347},{"alt":277,"title":277,"size":348,"location":351},{"width":349,"height":350},302,201,{"bucket":281,"key":352},"\u002Fmigrated-images\u002Fmagazine_150819.jpg",{"id":354,"created":355,"updated":356,"published":355},62,1439982217,1731353197]