EM1908F "Challenges in Diuretic Therapy: A Case Based Discussion" (IM GR-181619)

The discussion will review some of the obstacles that are encountered during the course of diuretic therapy for states of volume excess. The physiologic principles that underpin these challenging scenarios will be examined. Building upon on this foundation of understanding, the review will provide pragmatic solutions to these clinical problems. With this knowledge, the practitioner will have the tools necessary to overcome these common impediments to effective volume control in the hypervolemic syndromes.

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Target Audience

UT Southwestern faculty, fellows, residents and medical students, community physicians, nurse clinicians, physician assistants and nurses.

Learning Objectives

At the conclusion of this activity, the participant should be able to:

  • Understand some of the mechanisms of loop diuretic resistance in the treatment of nephrotic syndrome. Know how to overcome this resistance with and without the use of albumin infusions.
  • Understand some of the mechanisms that maintain a metabolic alkalosis during diuretic therapy for the hypervolemic syndromes. Understand the limits of carbonic anhydrase inhibitor therapy in this situation as well as the importance of potassium chloride supplementation in correcting the alkalosis.
  • Move beyond an understanding of hyponatremia that is based solely on volume status to one that views it as a disproportion between total body sodium and potassium content and total body water. From this foundation, understand how potassium supplementation and, occasionally, liberalized sodium intake, may be appropriate for managing the hyponatremia of hypervolemic states.
Course summary
Available credit: 
  • 1.00 AMA
Course opens: 
Course expires: 

Photo: Kamalanathan Sambandam, M.D.Kamalanathan Sambandam, M.D.
Associate Professor, Department of Internal Medicine
Program Director, Nephrology Fellowship
Medical Director, Parkland Hospital Renal Clinics
Division of Nephrology

Dr. Sambandam received his undergraduate degree at Rice University in Houston, Texas followed by his Doctor of Medicine at the University of Texas Medical Branch at Galveston. His Internal Medicine and Nephrology Subspecialty training was conducted at Barnes-Jewish Hospital/Washington University in Saint Louis. His main administrative roles include Program Directorship for the Nephrology Fellowship at UTSW and Medical Directorship of the Parkland Memorial Hospital Renal Clinics. His clinical and research interests lie in the fields of diuretic resistance and non-diabetic glomerular disease. He is the center Principal Investigator for two NIH-sponsored studies, the Nephrotic Syndrome Study Network and the Cure Glomerulonephritis Network.

Available Credit

  • 1.00 AMA


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