1. Diuretic Therapy

2. Overview Contrasting uses of diuretics in OR versus Critical Care
Lecture sections:
- Anatomy & Physiology
- Renal Effects of Anesthesia Drugs
- Diuretic Drugs by Class
- Intra-operative Uses
- Adjuvant Therapy

3. Renal Anatomy Size Regions Functional Unit Blood Supply
Tubular Systems
Hemodynamics
Hydraulics

4. Structure

5. Renal Physiology
Filtration
Reabsorption
Secretion
Minor functions

6. Nephron

7. Tubular segment characteristics

8. Juxta-glomerular complex

9. Nephron

10. Counter-Current Mechanism
What is it?
How does it work?
Why is this so important?

11. Counter-current mechanism in kidney

12. Tubular fluid osmolarity

14. Hormonal Regulation Anti-diuretic Hormone (ADH) Aldosterone
Renin-angiotensin
Atrial Natriuretic Peptide (ANP)
Prostaglandins
Epinephrine/Nor-epinephrine
Dopamine

15. Anti-diuretic hormone feedback

16. Aldosterone & renin-angiotensin

17. Responses to Anesthetic Agents
Inhaled agents
Intravenous agents
Regional anesthesia

18. Diuretic Classification
Osmotic agents
Carbonic Anhydrase Inhibitors
Loop Diuretics
Aldosterone Antagonists
Potassium-sparing Agents
Thiazide Diuretics
Xanthines

19. Diuretic sites of action

20. Intra-operative Uses ICP reduction IOP reduction
Renal failure prophylaxis
Oliguria assessment & treatment
General strategies

22. Rhabdomyolysis
Peaked T-waves
Myoglobinuria

23. Causes Muscle trauma/ischemia/exertion Substance abuse Medication
Toxins
Electrical injury
Hyperthermia
Infections
Transfusions
Electrolyte disorders

24. Genetic disposition Glycolysis defect Lipid metabolism defects
Mitochondrial myopathies
Muscular dystrophies
G-6-PD deficiency
Collagen vascular disorders

25. Diagnosis History Deteriorating renal function Tea-colored urine
Peaked T-waves
Evidence of coagulopathies

26. Treatment IV fluids Electrolyte correction Acid-base correction
Diuretics
Dialysis or hemofiltration
Correction of underlying problems

28. Adjuvant Therapy
Fenoldopam
N-acetylcysteine
Nesiritide