Diuretic Resistance

Step-by-step management of refractory volume overload using Sequential Nephron Blockade.

Step 1

Basics & Adherence

Step 2

Maximize Loop

Step 3

Sequential Blockade

Step 4

Continuous Infusion

Step 5

Ultrafiltration

Step 1: The Basics

Before escalating drugs, ensure the foundation is solid.

Sodium Restriction: Strict < 2g/day. (High Na intake overrides diuretic effect).
Fluid Restriction: < 1.5L/day if hyponatremic.
Medication Adherence: Verify patient is actually taking the meds.
NSAIDs: Stop all NSAIDs (they constrict afferent arteriole).

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