Which medications in the drug class Diuretics are used in the treatment of Herpes Simplex Encephalitis?

Updated: Jul 17, 2018
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Diuretics

These agents are used for the management of increased intracranial pressure in complications resulting from herpes simplex encephalitis.

Furosemide (Lasix)

Furosemide is a loop diuretic that increases the excretion of water by interfering with the chloride-binding co-transport system, which, in turn, inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. It increases renal blood flow without increasing the filtration rate. The onset of action generally is within 1 hour. It increases potassium, sodium, calcium, and magnesium excretion.

Furosemide is used in the acute setting for reduction of increased ICP. The proposed mechanisms in lowering ICP include following: (1) suppression of cerebral sodium uptake, (2) carbonic anhydrase inhibition resulting in decreased CSF production, and (3) inhibition of cellular membrane cation-chloride pump, thereby affecting the transport of water into astroglial cells.

The dose must be individualized to the patient. Depending on the response, administer at increments of 20-40 mg, no sooner than 6-8 hours after the previous dose, until desired diuresis occurs. When treating infants, titrate with 1-mg/kg/dose increments until a satisfactory effect is achieved.

Mannitol (Osmitrol)

Mannitol reduces cerebral edema with the help of osmotic forces, and it decreases blood viscosity, resulting in reflex vasoconstriction and lowering of ICP.


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