Management And Treatment Of Patients With Heart Failure (Oxygen Therapy And Diuretics)
Some of the basic management protocols on patients with Heart failure are Oxygen and Drug therapy. Of the many drug types that exist, we will discuss the Diuretics
Oxygen Inhalation: In dyspneic subjects, administration of oxygen by nasal catheter (2 liters/min) or by oxygen mask (4-6 liters/min) helps in providing relief and improving cardiac function. While administering oxygen by nasal catheter, care should be taken to insert the catheter up to the nasopharynx and the patient should be asked to keep his mouth closed and avoid talking so that the oxygen does not escape.
Diuretics are indicated in all cases of severe and moderate heart failure. In acute pulmonary edema, they form the sheet anchor of therapy. They relieve the fluid overload by eliminating salt and water in urine. Several diuretics are available for use. The powerful diuretics such as furosemide, ethacrynic acid or bumetanide are to be used in emergency situations. In mild cases, the less powerful drugs such as thiazides can be employed.
The most widely used diuretic is furosemide in a dose of 40-80 mg orally or 20-100 mg intravenously. The effect is evident within 1-2 hours of oral dose and within 30 minute of the intravenous dose. Even in the presence of renal disease, furosemide can be safely given, but the effective dose has to be higher (up to 500 mg or more). Response to diuretics is very salutary with prompt relief of dyspnea, clearance of edema and improvement of cardiac function. In patients with bladder neck obstruction, urine may not be passed, but distention of the bladder should be looked for and urine removed by catheterisation. The effect of an oral dose lasts for 4-6 hours. Except in emergencies, diuretics are given early during day time so as to avoid disturbance at night.
Common adverse side effects include excessive diuresis and hypokalemia. Hyperuricemia and hyperglycemia may develop on long-term use. Among these hypokalemia is more dangerous. Hypokalemia is avoided by the administration of potassium chloride in a dose of 1-2g thrice daily given orally as a mixture or in the form of any of the commercially available preparations. Fruit juices and coconut water are rich in potassium but in a grave situation they should not be relied upon. Estimation of serum potassium helps in establishing the presence of hypokalemia.
If the serum levels fall below 2.2 meq/liter, potassium chloride should be given intravenously by slow infusion. Concurrent administration of potassium sparing diuretics like spironolactone (25mg four times daily), triamterine (50 mg once or twice daily) or amiloride (5-20 mg/day) obviates hypokalemia though their diuretic action is only weak.
Overzealous use of diuretics may lead to excessive loss of salt and water resulting in a hypovolemic state since more fluid is eliminated from the vascular compartment than is reabsorbed from edematous tissues. This causes a shock-like picture with hypoperfusion of tissues in the presence of edema. The cardiac output remains low. The response to further administration of diuretics intensity of diuretic therapy and careful electrolyte repletion.
© 2013 Funom Theophilus Makama