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New diuretics - bumetanide and metolazone

Abstract

The temptation to use a powerful and rapidly acting diuretic in every patient who needs one, often results in the use of frusemide as an all-purpose diuretic. Unfortunately there is no such thing as an all-purpose diuretic. Although frusemide is very valuable in acute pulmonary oedema, thiazide-resistant oedema, ascites due to liver disease and renal failure, the intense diuresis it can produce may cause orthostatic hypotension in the elderly, and acute electrolyte imbalance which can be serious, especially in digitalised patients. For many patients with mild or moderate heart failure a less powerful diuretic, such as a thiazide, will be safer, and just as effective. Two new diuretics have recently been promoted for many of these situations, but it is by no means clear in which of them they offer a tangible advantage.

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