Pharmacotherapy of edema
Treatment of edematous syndrome is complex, includingtreatment of the underlying disease that caused the development of edema. If we talk about the treatment of CHF, glomerulonephritis, Quincke edema or myxedema - for each of these diseases there are ways and schemes of treatment. For example, with CHF on the background of carronocardiosclerosis, surgical treatment will be optimal (coronary artery bypass grafting, as a rule, gives a good result). And with the swelling of Quincke - its emergency care, etc.
Nevertheless, for almost all edema, there are a number of common measures that produce a good result, but the most effective, at the same time, is the appointment of dehydration therapy, i.e. diuretics.
The appointment of bed rest is necessary whenmassive swelling of any origin. It is suggested that this will improve the response to diuretics by increasing renal perfusion. Bandaging the legs or other edematous areas with an elastic bandage can significantly reduce the swelling of the tissues. In addition, this method causes an increase in diuresis and sodium naresis. In connection with the emergence of effective diuretics to mechanical removal of edematous fluid is rarely resorted, but this method is not excluded from medical practice. Often after the paracentesis, the effect of diuretics is increased. Limiting the intake of sodium and water with food is an important component of edema treatment. With more generalized edema or a combination of local edema with significant swelling of the tissue, additional measures are required to increase excretion in the urine of both salt and water, using either diuretics alone or a combination of them with other methods (for example, diet). Assign a diet with restriction of consumption of table salt to 1-1.5 g per day (with treatment with diuretics 3-4 g per day), liquids up to 1-1,2 l. sometimes up to 600-800 ml. More significant, but short-livedLimitations are advisable for edema caused by glomerulonephritis. A diet with a sharp restriction on the amount of sodium is poorly tolerated by most patients, and prolonged use of it can aggravate the disturbance of water-electrolyte metabolism, cause chlorpenic azotemia, and salt depletion syndrome. Excessive restriction of fluid intake in the presence of edema can lead to symptoms of hypernatremia. When giponokoticheskih edema is prescribed protein-rich food (excluding cases of kidney and liver failure). To reduce the capillary permeability used vitamins B1. C and P.
Treatment with diuretics alone has a numberdisadvantages: there is a large loss of salt and water from the vascular bed than from the interstitial space, the increased volume of which is actually the edema. With a negative balance of fluid, the volume of blood plasma drops sharply, which in some cases can lead to the development of collapse. With heart failure, a decrease in the volume of circulating blood leads to a decrease in venous return to the heart, which is even more responsible for a small cardiac output. In addition, each diuretic has, as a rule, a side effect.
The most widely used are sulfonamidediuretics, which are divided into two subgroups: thiazide and non-azide. Most of them are capable of inhibiting carbonhydrase and acting on the proximal renal tubule. In the initial part of the nephron they inhibit the active transport of sodium.
Diuretics acting in the area of the nephron loop(furosemide, ethacrynic acid, bumetanide and triflocin) are most effective - they are able to increase urinary sodium excretion up to 20-30% of the filtered amount.
Potassium-sparing diuretics (veroshpiron,triamterene) differ in structure, but they act on the same nephron site-the distal tubule; have a weak effect (an increase in excretion of 2-3% of the filtered amount). Side effects are few. They are used more often in combination with other diuretics.
Osmotic diuretics, organic mercury diuretics have limited application.
To prevent and partially treat edema in venous insufficiency, flavonoids, horse chestnut extracts (escusan), rutin, venoruton, esflazid, gliwenol, etc. are used.
Despite these features of diureticsare very effective and extremely useful medicines. Treatment should be controlled by measuring diuresis and body weight of patients, as well as by studying the dynamics of Na + and K + blood ions.