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Brilliant Board Review & CME
🎙️ Episode 33: Spot Check: Urinary Sodium and Diuretic Response
🧠 Clinical Tool:
Spot urine sodium 2 hours after IV loop diuretic.
If <50–70 mmol/L → inadequate response.
Consider doubling dose or switching loop agents.
💡 Tips:
Also assess urine output in first 6 hours (<100–150 mL/hr = poor response).
Less helpful after 24 hrs or in chronic diuretic users.
🧩 Clinical Takeaway:
Fast, practical guide to assess diuretic effectiveness in acute decompensated HF.
let's talk about using spot urinary sodium for diuretic response. It can be difficult to find the right dose of diuretic for a patient in active heart failure. There's many different approaches, including the book. House of god has their own approach. This is a proposal of using a spot urine sodium. What does that mean? We're just grabbing the sodium level at a point in time, and it's less than two hours after a diuretic, and we're probably talking about IV diuretics. If it's less than 50 to 70, post two hours diuretic, consider doubling the dose. Or if urine output is less than 100 to 150 milliliters an hour in the first six hours, consider doubling the dose of diuretic. Now, is this perfect? No, no, no, no. And do you do this blindly? No, remember, your patients are an N of one and you actually have to examine them. Think about it. What does this doesn't take into account for Well, it doesn't take into account for the severity of distribution of fluid. We have a lot of patients that you're going to have are extravascular, fluable, intervascular, depleted, so you kind of have to get those fluids into the vascular. Remember, the loops don't work if there's no fluid in the lupohenoline to diuresis, so you have to get the fluid to the lupohenoline. It's less useful after one day. So the first day, the first 24 hours, you can try this. After, high urine output decreases the sodium excretion with rapid decongestion limited by the kidney function. So in a lot of these studies the kidney function needs to be normal to make this work.
Speaker 1:It also doesn't intake for the high salt intake. Well, what gives you a high salt intake? Well, bicarb. You have so many bicarb. One of those 50 amps is going to have 50 milcovin amps is going to have about two to three grams of sodium in it. Also too is antibiotics. Antibiotics are huge sources Piper, saline, tasobacta Two to three grams and you can get in a day even more depending how you're dosing it. Chronic use of diuretics will also throw this off. Remember this is less predictive after first 24 hours. But if someone's coming in for chronic diuresis, like they're using chronic diuresis, less likely to be helpful and this will work for loops. But when we start using new things, like the newer things, like the Vaptams or the SGL2 inhibitors and this spot, urine sodium may not be as helpful.