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

Updated: Aug 07, 2018
  • Author: David S Howes, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Diuretics

These agents are used in patients with hydrocephalus and increased intracranial pressure (ICP) when more aggressive diuresis is desired.

Furosemide (Lasix)

Furosemide is a loop diuretic that increases 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.

The proposed mechanism for furosemide in lowering intracranial pressure include (1) lowering cerebral sodium uptake, (2) affecting water transport into astroglial cells by inhibiting the cellular membrane cation-chloride pump, and (3) decreasing cerebrospinal fluid production by inhibiting carbonic anhydrase.

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 may reduce pressure in the subarachnoid space by creating an osmotic gradient between cerebrospinal fluid in the arachnoid space and plasma. This agent is not intended for long-term use.

Initially assess for adequate renal function in adults by administering a test dose of 200 mg/kg, given IV over 3-5 minutes. This should produce a urine flow of at least 30-50 ml/h of urine over 2-3 hours.

In children, assess for adequate renal function by administering a test dose of 200 mg/kg, given IV over 3-5 minutes. This should produce a urine flow of at least 1 mL/kg over 1-3 hours.


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