Loop Diuretics: Side and Adverse Effects (Nursing)

by Rhonda Lawes

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    00:00 Okay here's a question for you. What are the signs and symptoms of dehydration a nurse should monitor for? Okay, now where I come from we're really up on dehydration because it's very hot and we get those little football players. They have been outside for 2 days. Right? And those kids come in super dehydrated but the same thing can happen to a patient who is on diuretics. So they'll have a dry mouth, they'll be really thirsty, they'll have tiny amounts of urine so we call that oligouria, scanty urine and that urine will be dark. Remember, a good rule of thumb for all of us is to drink enough water everyday that your urine is a pale yellow. If someone's dehydrated, dry mouth, very thirsty, tiny amounts of urine and what they do put out will be very dark. So, why do we care about dehydration? Well, because severe dehydration can lead to hypovolemia. That means low volume. When we have low volume, you'll have low blood pressure and can put your patient at risk for shock. So, also if that's not enough fun for your patient, they're severely dehydrated, they have low volume, low blood pressure, possibly shock, the more dehydrated the patient is, it also puts them at a risk for clots. Okay so let's review. Why do I care about dehydration in diuretics? Because diuretics put my patient at risk for dehydration. Clinically that's what a patient might tell me. "Man my mouth feels really dry and I'm so thirsty" and when you assess their urine there's not going to be very much of it and it's going to look really really dark. Why I care as a nurse is because I want to watch them for hypovolemia and blood pressure that's too low, now I've got a perfusion problem and their patient could go into shock. Also this puts the patient at risk to develop clots. This actually happened to me. I was extremely dehydrated and had a lot of other risk factors but I ended up developing a clot in my leg that went to my lung and ended up in a pulmonary embolus. So I know for personal experience that dehydration, severe dehydration can lead a person to develop clots. So watch your patients closely for these signs.

    02:20 We want to pull off enough fluid but still keep them in balance so they don't become overly dehydrated. Now let's talk about some other fun adverse facts of loop diuretics. The most common is excessive loss of electrolytes. Remember the goal is to lose the electrolytes so the water will follow. Right? Lose that sodium so the water follows. That's our goal to pull fluid off the body.

    02:44 Anytime I have less volume I'm at risk for hypotension or low blood pressure. I'm also going to be at risk for low potassium. Let's pause for a minute right there. Stop and just put a star by that in your notes. Low potassium, hypokalemia. Because we're going to come back to that but I want you to really stress that fact in your brain. Loop diuretics cause low potassium and there's some significant impact of that in just a few minutes. We'll talk about it. Loop diuretics are also ototoxic. Toxic meaning bad for. Right? Toxic to my ears. That's what oto means. So when you're giving a loop diuretic particularly when you're giving an IV dose, you want to give it very slowly because it can cause ear damage. Now it's usually reversible but make sure you write yourself a note by ototoxicity, IV push very slow to remind yourself and then the idea is we want to protect their ears. Now there's some other kind of weird ones. The most common are you lose electrolytes, you might have low blood pressure, it goes after your potassium and it can be hard on your ears with IV doses. Some other things are it can raise your blood sugar. That's what hyperglycemia is. This could be particularly problematic if your patient is diabetic. Hyperuricemia. Okay, emia means "in my blood," uric is like uric acid, hyper means too much. So break that word then in your mind. Hyper, too much. Uric, uric acid. Emia meaning "in my blood." So I'm going to have extra uric acid in my blood. If your patient has a propensity towards developing gout, that's a build-up of uric acid in the joints and it is excruciating. You've ever seen a patient with an episode of gout, it is really really painful for them. So if I know a patient is prone to gout and they are on Lasix, I really want to watch for that closely, they'll likely need to be in a treatment for gout. You want to avoid loop diuretics in pregnancy and it might also mess with your cholesterol levels. So it might raise the bad cholesterol we call the LDL and lower the HDL so we'll watch for that kind of impact. The odds that somebody in CHF is taking a loop diuretic are pretty high and also we're going to be watching their cholesterol levels because of their cardiovascular risk. So we just kind of have to weigh out the benefits and the risks. Now this will also increase the excretion of magnesium and calcium. So looking at diuretics, just know that they impact all the electrolytes in one way or the other. With loop diuretics, I'm going to particularly watch the sodium and potassium. So just for fun, see if you know the symptoms of hypomagnesemia and hypocalcemia a nurse should monitor for. Now hypo means low, magnesia is magnesium so low magnesium and low calcium. Can you remember what those clinical symptoms are or what a patient might say to you? Low magnesium is muscle weakness, they might have some tremors or dysrhythmias. Low calcium, they have tight knee. Remember that Chvostek sign where you tap the sardonic kind of tetany or you put a blood pressure cuff on it's ____ so I would have that tetany reaction. Those are some signs and symptoms of low magnesium and low calcium. Now here's some interactions you want to know about. Digoxin and furosemide really has some potential problems.

    06:22 We use digoxin to treat CHF. The problem is if a patient has low potassium for any reason, so please underline that, low potassium for any reason increases your risk of dig toxicity. So low potassium, write the other word for low potassium. Right, it's hypokalemia. So hypokalemia for any reason increases a patient's risk of digoxin toxicity. Remember furosemide is a loop diuretic and can cause hypokalemia or low potassium. So patients who are in digoxin and on furosemide are going to likely going to have to have some type of potassium replacement because we don't want to increase the risk for digoxin toxicity. So that's a classic example of furosemide having a wee bit of a problem when you give it with a medication like digoxin. We do it, we just have to monitor the patient to make sure that they're safe.

    About the Lecture

    The lecture Loop Diuretics: Side and Adverse Effects (Nursing) by Rhonda Lawes is from the course Medications for Fluid and Electrolyte Imbalances (Nursing). It contains the following chapters:

    • Signs and Symptoms of Dehydration
    • Adverse Effects of Loop Diuretics
    • Hypomagnesia and Hypocalcemia
    • Interaction: Digoxin and Furosemide

    Included Quiz Questions

    1. Dry mouth
    2. Low urine output
    3. Thirst
    4. Dark urine
    1. Ototoxicity
    2. Hypertension
    3. Hypoglycemia
    4. Hypercalcemia
    1. Hypocalcemia
    2. Hyperkalemia
    3. Hypomagnesemia
    4. Hypercalcemia

    Author of lecture Loop Diuretics: Side and Adverse Effects (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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