Ethacrynic Acid

INTRODUCTION

Indications

Edema due to heart failure, hepatic impairment, or renal disease. Short-term management of ascites due to malignancy, idiopathic edema, and lymphedema. Alternative diuretic in patients with an allergy to sulfonamides.

Action

Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium. Effectiveness persists in impaired renal function. Therapeutic Effects: Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions).

Adverse Reactions/Side Effects

CNS: confusion, fatigue, headache, nervousness, vertigo. EENT: hearing loss, tinnitus. CV: hypotension. GI: abdominal pain, anorexia, diarrhea, dry mouth, dysphagia, nausea, vomiting. GU: excessive urination, hematuria. Derm: rash. Endo: hyperglycemia, hyperuricemia. F and E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis. Hemat: AGRANULOCYTOSIS, neutropenia, thrombocytopenia. Misc: fever, increased BUN.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of agranulocytosis and neutropenia (fever, sore throat, mucosal lesions, signs of infection) or thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs immediately to the physician.

• Monitor signs of fluid, electrolyte, or acid-base imbalances, including dizziness, drowsiness, blurred vision, confusion, hypotension, or muscle cramps and weakness. Report excessive or prolonged symptoms to the physician.

• Assess dizziness and vertigo that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor drug effects by assessing peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Also monitor signs of pulmonary edema such as dyspnea and rales/crackles (See Appendix K). Document whether peripheral and pulmonary symptoms are controlled adequately by diuretic therapy.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Monitor signs of hyperglycemia such as drowsiness, fruity breath, increased urination, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

Interventions

• Implement fall-prevention strategies, especially in older adults or if patient exhibits sedation, dizziness, vertigo, or other impairments that affect gait and balance (See Appendix E).

• Use caution during aerobic exercise, especially in hot environments. Increased sweating will cause fluid and electrolyte loss and may exaggerate diuretic side effects (dizziness, muscle cramps, and so forth).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Remind patient and family/caregivers that diuretics typically increase urine output. Any unusual problems such as ...