Analysis of usage of diuretics in medical intensive care unit of SIMS-Shimoga a tertiary care hospital


  • H. Vedavathi Department of Pharmacology, Shimoga Institute of Medical Sciences, Shimoga, Karnataka
  • Shreenivas P. Revankar Department of Pharmacology, Shimoga Institute of Medical Sciences, Shimoga, Karnataka



Intensive care unit, Diuretics, Rational, Retrospective, Polypharmacy


Background: Patients are admitted in the intensive care unit (ICU) with a history of various acute and chronic clinical conditions associated with organ failures. Compared to the patients admitted in the general wards the mortality and morbidity are high in ICU patients. The patients in ICU are subjected to multiple drugs; diuretic agents are liberally and deliberately used in this setup despite the lack of evidence supporting their benefits.

Methods: The main aim of the study was to know the extent of use of diuretics in the ICU set up, to categorize the use of diuretics in different clinical conditions and different classes of diuretics used. The study also tried to determine adverse events and outcome in critically ill patients. The study was a retrospective cross-sectional of 3 months duration conducted in all patients admitted in the medical ICU of the tertiary care center. The study mainly concentrated on the usage of diuretics and related aspects.

Results: Loop diuretics (54.81%) composed the major class, thiazides (30.84%). Potassium sparing diuretics (7%) and osmotic diuretics (7%) and carbonic anhydrase inhibitors (1%) were the other class of diuretics. The classes of drugs used in ICU along with diuretics were antibiotics (30%), analgesics (9.5%), anti-inflammatory (6.36%), and drugs acting on blood (10.18%) of total drugs used in ICU. Antacids/laxatives (7.3%) and antiemetic (4.8%), the rest of drugs (15%) of drugs used in ICU.

Conclusion: In almost 95% of cases, the combination of other drugs along with diuretics was considered to be rational.


Safar P, Dekornfeld TJ, Pearson JW, Redding JS. The intensive care unit. A three year experience at Baltimore city hospitals. Anaesthesia. 1961;16:275-84.

Weil MH, von Planta M, Rackow EC. Critical care medicine: Introduction and historical perspective. In: Shoemaker W, editor. Textbook of Critical Care Medicine. Philadelphia: WB Saunders; 1988: 1055-73.

European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21(6):1011-53.

Srivastava SK. A Complete Textbook of Medical Pharmacology. 1st Edition., Vol. 1. India: Avichal Publishing Company; 2012.

Udaykumar P. Medical Pharmacology. 3rd Edition. New Delhi: CBS Publishers; 2006: 113-27.

Brenner GM, Stevens CW. Pharmacology. 3rd Edition. Cheltenham: Elsevier Publishers; 2012: 138-9.

Tripathi KD. Essentials of Medical Pharmacology. 7th Edition. New Delhi: Jaypee Publications; 2013: 579-93.

Venkataram R, Kellum JA. The role of diuretic agents in the management of acute renal failure. Contrib Nephrol. 2001;(132):158-70.

Ellison DH. The physiologic basis of diuretic synergism: its role in treating diuretic resistance. Ann Intern Med. 1991;114(10):886-94.

Sica DA, Gehr TW. Diuretic combinations in refractory Oedema states: pharmacokinetic-pharmacodynamic relationships. Clin Pharmacokinet. 1996;30(3):229-49.

Kellum JA. Use of diuretics in the acute care setting. Kidney Int Suppl. 1998;66:S67-70.

Anand IS, Kalra GS, Harris P, Poole-Wilson PA, Panzali A, Guili F, et al. Diuretics are essential and sole treatment in chronic heart failure. Cardiosource. 1997;18:852-7.

Ghajar J, Hariri RJ, Narayan RK, Iacono LA, Firlik K, Patterson RH. Survey of critical care management of comatose, head-injured patients in the United States. Crit Care Med. 1995;23(3):560-7.

Jeevaratnam DR, Menon DK. Survey of intensive care of severely head injured patients in the United Kingdom. BMJ. 1996;312(7036):944-7.

Park K. Parks Text Book of Preventive and Social Medicine. 23rd Edition. India: Bhanot Publishers; 2015: 342-50.




How to Cite

Vedavathi, H., & Revankar, S. P. (2016). Analysis of usage of diuretics in medical intensive care unit of SIMS-Shimoga a tertiary care hospital. International Journal of Basic & Clinical Pharmacology, 4(5), 941–945.



Original Research Articles