The site of action appears to be the cortical diluting segment of the ascending limb of Henle's loop of the Nephron. After applying the strict inclusion and exclusion criteria, we arrived at a final study cohort of 55 patients (33 patients in the oral metolazone group and 22 patients in the IV chlorothiazide group). A cut‐off date of June 1, 2008, was chosen as this is when the electronic medical record was first implemented at our institution, which was used to facilitate and ensure the accuracy of the data collection process. Figure Baseline demographics were similar for each of the two treatment groups (Table There were some notable differences in total diuretic dosing between the groups during the study period. The study was divided into two parts. Potentiation of aminoglycoside ototoxicity has not been tested for bumetanide. Name must be less than 100 characters ScienceDirect ® is a registered trademark of Elsevier B.V.A comparison of hydrochlorothiazide and chlorothiazide in the treatment of hypertensionScienceDirect ® is a registered trademark of Elsevier B.V. In part B, combined hydrochlorothiazide-furosemide therapy was used to treat three additional patients who had an inadequate response to either diuretic alone. This site needs JavaScript to work properly. Spironolactone is effective in lowering the systolic and diastolic blood pressure in patients with primary hyperaldosteronism. Hypokalemia. The remaining program was unchanged. Rather, it is a nonbacteriostatic sulfonamide possessing a chemical structure and pharmacological activity distinctly different from the bacteriostatic sulfonamides. Most of the drug is excreted in the unconverted form in the urine. Metolazone and furosemide administered concurrently have produced marked diuresis in some patients where edema or ascites was refractory to treatment with maximum recommended doses of these or other diuretics administered alone. By continuing you agree to the Copyright © 2020 Elsevier B.V. or its licensors or contributors. In part A, five patients had an inadequate response to furosemide in doses of 160 to 240 mg/day followed a strict protocol in order to compare the effect of increased doses of furosemide with combined hydrochlorothiazide-furosemide administration. Potassium excretion is also increased by bumetanide, in a dose-related fashion. A detailed review of each patient's electronic medical record was used to obtain and/or confirm patient demographics, comorbid conditions, vital sign information, measurements of total fluid intake and urine output (UOP), home medication records, inpatient medication administration records, echocardiogram reports, and laboratory values. Successful treatment with bumetanide following instances of allergic reactions to furosemide suggests a lack of cross-sensitivity. Significant hypokalemia, however, was quite common, occurring in nearly half of the patients from both groups.In those patients with the most impaired renal function (restricted to those with a creatinine clearance of 15–30 mL/min), there was no significant difference in net UOP at 72 h between the metolazone group (n = 21; median net UOP of 4696 mL, IQR 2872–6858) and the chlorothiazide group (n = 14; median net UOP 3240, IQR 2218–6675) (In terms of acuity/severity of illness, the use of inotropic therapy during the hospitalization was similar between the metolazone group (six patients on dobutamine, one patient on milrinone) and the chlorothiazide group (seven patients on dobutamine, one patient on dobutamine plus dopamine) (The management of diuretic resistance in patients hospitalized with ADHF remains a complex, difficult to treat condition with widely varying and often empiric strategies. Jonathan Rich MD contributed to the concept/design, data analysis/interpretation, critical revision of the article, and approval of article.Please check your email for instructions on resetting your password.