Diuresis

Definition

Diuresis is increased excretion of urine. It may be physiologic (after large fluid intake), pathologic (diabetes insipidus, hyperglycemia), or therapeutic (from diuretic medications).

Diuretic Classes

• Loop (furosemide, bumetanide): Most potent; for CHF, pulmonary edema. Monitor K, Mg, Na, hearing.
• Thiazide (HCTZ): Mild-moderate diuresis for hypertension, such as hypokalemia, hyperglycemia, hyperuricemia.
• Potassium-sparing (spironolactone): Hypertension, hyperaldosteronism, CHF. Hyperkalemia risk; gynecomastia.
• Osmotic (mannitol): Reduce ICP, IOP. Avoid in anuria.
• Carbonic anhydrase inhibitors (acetazolamide): Glaucoma, altitude sickness.

Nursing Monitoring

Daily weights, I&O, serum electrolytes (especially K+), orthostatic BP, hearing, and signs of dehydration. Give in the morning to avoid nocturia. Teach patients to rise slowly, limit sodium, and eat potassium-rich foods on loop/thiazide diuretics (unless on ACE/ARB/K-sparing).

NCLEX Relevance

Hypokalemia + digoxin = toxicity. Spironolactone causes hyperkalemia.