Diuresis ( ) increases the urine and physiological processes that result in the increase. It involves the production of extra urine in the kidney as part of the homeostatic maintenance of body fluid balance.
In healthy people, drinking extra water produces mild diuresis to keep the body's water balance. Many people with health problems such as heart failure and kidney failure require diuretic drugs to help their kidneys deal with excess fluid edema. These medications help the body rid itself of extra water through extra urine. The concentration of electrolytes in the blood is closely related to the fluid balance, so any action or problem involving fluid intake or output (such as polydipsia, polyuria, diarrhea, heat exhaustion, initiation or altering diuretic doses, etc.) may require management. electrolytes, either through self-care in mild cases or with help from health professionals in moderate or severe cases.
Sometimes the connotative distinction is felt between diuresis in the sense of an appropriate increase (as in successful diuretic therapy that controls symptoms well) and polyuria in the sense of an inappropriate increase, which is, the excess (as in the failed oral antihyperglycemic therapy that needs to be increased to achieve control). However, sometimes these words are only synonymous.
Video Diuresis
Diuresis osmotik
Osmotic diuresis is an increase in the level of urination caused by the presence of certain substances in a small tube of the kidney. Excretion occurs when substances such as glucose enter the renal tubules and can not be reabsorbed (due to the pathological state or the normal nature of the substance). This substance causes an increase in osmotic pressure within the tubules, causing water retention within the lumen, and thereby reducing water reabsorption, increasing urine output (ie diuresis). The same effect can be seen in therapies such as mannitol, which is used to increase urine output and decrease extracellular fluid volume.
Substances in the circulation can also increase the amount of fluid in circulation by increasing blood osmolarity. It has the effect of pulling water from the interstitial space, making more water available in the blood and causing the kidneys to balance it by removing it as urine. In hypotension, colloids are often used intravenously to increase circulating volume in themselves, but because they exert a certain amount of osmotic pressure, water is also removed, increasing the circulating volume. As blood pressure increases, the kidneys remove excess fluid as urine. Sodium, chloride, potassium is excreted in Osmotic diuresis, derived from Diabetes Mellitus (DM). Osmotic diuresis produces dehydration from classical polyuria and polydipsia (excessive thirst) associated with DM.
Maps Diuresis
Forced diuresis
Forced Forcedis (increased urine formation by diuretics and fluids) may increase excretion of certain drugs in the urine and is used to treat drug overdose or intoxication of these drugs and haemorrhagic cystitis.
Diuretic
Most drugs are weak acid or weak base. When urine is made alkaline, the elimination of acidic drugs in urine increases. The opposite is true for alkaline drugs. This method is only therapeutic significance in which the drug is excreted in the active form in the urine and in which the urine pH can be adjusted to levels above or below the pK value of the drug's active form. For acidic drugs, the pH of the urine should be above the pK value of the drug, and be discussed for basic drugs. This is because the ionization of the acidic drug increases in the alkaline urine and the ionized drug can not easily pass through the plasma membrane so it can not reinsert blood from the renal tubules. This method is not effective for highly bonded drugs with proteins (eg tricyclic antidepressants) or those with large distribution volumes (eg paracetamol, tricyclic antidepressants).
For alkali diuresis forced , sodium bicarbonate is added to the intravenous fluids to make blood and, in turn, alkaline urine. Potassium replacement is very important in this arrangement because potassium is usually lost in the urine. If the blood potassium levels run out below normal levels, then hypokalemia occurs, which encourages the retention of bicarbonate ions and prevents the excretion of bicarbonate, thus interfering with the alkalinization of urine. Forced alkaline diuresis has been used to increase the excretion of acidic drugs such as salicylate and phenobarbiton, and is recommended for rhabdomyolysis.
For forced acid diuresis , ascorbic acid (vitamin C) is sometimes used. Ammonium chloride has also been used for forced acid diuresis but is a toxic compound. However, usually, this technique produces only a slight increase in drug renal cleansing. Forced acid diuresis is rarely done in practice, but can be used to increase the elimination of cocaine, amphetamine, quinine, quinidine, and strychnine when poisoning by these drugs has occurred.
Rebound diuresis
Rebound diuresis refers to a sudden resurgence of the flow of urine that occurs during recovery from acute renal failure. In acute renal failure, particularly acute tubular necrosis, the tubules are blocked with cellular matter, especially necrotic decay of dead cells. These debris block the flow of filtrate, resulting in reduced urine output. Nephron artery supply is associated with filtration equipment (glomerulus), and decreased perfusion leads to reduced blood flow; usually this is the result of pre-renal pathology.
The renal resorptive mechanism is very energetic, using nearly 100% of the supplied O 2 . Thus, the kidneys are very sensitive to the decrease in blood supply. This phenomenon occurs because the kidney flow is restored before the normal resorption function of the renal tubules. As you can see in the graph, the flow of urine recovers rapidly and then goes beyond the typical daily output (between 800 mL and 2 l in most people). Because the capacity of renal resorption takes longer to rebuild, there is a small lag in the function that follows the flow recovery. A good reference range for plasma creatinine is between 0.07-0.12 mmol/L.
Immersion diuresis
Immersion of diuresis is caused by immersion of the body in water (or equivalent fluid). This is mainly due to lower temperatures and pressure.
The component temperature is caused by water drawing heat away from the body and causing vasoconstriction of blood vessels in the body to save heat. The body detects increased blood pressure and inhibits the release of vasopressin (also known as the antidiuretic hormone (ADH)), leading to increased urine production. The pressure component is caused by hydrostatic pressure of water that directly increases blood pressure. Its meaning is indicated by the fact that the water temperature does not substantially affect the degree of diuresis. Partial immersion of only limbs does not cause increased urination. Thus, the hand in a warm water trick (soaking the hands of the person sleeping in water to make it urinate) does not have the support of the immersion diuresis mechanism. On the other hand, sitting up to the neck in the pool for several hours clearly increases the excretion of water, salt, and urea.
cold induced diuresis
Cold diuresis induced, or cold diuresis, is a phenomenon that occurs in humans after exposure to the hypothermic environment, usually during mild to moderate hypothermia. Presently it is thought to be caused by a redirection of blood from the extremities to the nucleus due to peripheral vasoconstriction, which increases the volume of fluid in the nucleus. Overall, acute exposure to cold is thought to cause a diuretic response due to an increase in mean arterial pressure. Renal artery cells experience increased blood pressure and kidney signals to secrete excess fluid in an attempt to stabilize the pressure. The kidney increases urine production and fills the bladder; when the bladder is filled, the individual can then feel the urge to urinate. This phenomenon usually occurs after the mental function decreases to levels far below normal. Cold diuresis has been observed in cases of unintentional hypothermia and the side effects of therapeutic hypothermia, particularly during the induction phase.
See also
References
Further reading
- Hunt NC (February 1967). "Immersion diuresis". Aerosp Med . 38 (2): 176-80. PMIDÃ, 6040343
- Nyquist PA, Schrot J, Thomas JR, Hyde DE, Taylor WR (2005). "Desmopression Prevents Diuresis Immersion and Improves Physical Performance After Long Duration Dives". Technical Report of the US Naval Medical Research Center . NMRC-2005-001 . Retrieved 2008/07/04
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