Which condition would the nurse monitor for in a patient receiving hydrochlorothiazide?
Monitoring a person on diuretics is necessary to assess response to treatment and to prevent adverse events, particularly electrolyte imbalances and decline in renal function. Show
View / Download pdf version of this article Why do we monitor patients taking diuretics and what do we monitor?Monitoring a person on diuretics is necessary to assess response to treatment and to prevent adverse events, particularly electrolyte imbalances and decline in renal function (see Tables 1 and 2). People with hypertension should have their blood pressure measured every six months and more often if uncontrolled or unstable. People with heart failure should be assessed at least six monthly and more often if clinical condition or medication is changed. The following is assessed:1
When do we monitor?The frequency of monitoring depends on the clinical condition of the patient and which diuretic they are taking. See Tables 1 and 2 for diuretic monitoring advicePatients with heart failure require closer monitoring than those with hypertension People with heart failure should have their electrolytes and creatinine assessed before initiation of diuretics and then at one week. Creatinine and electrolytes can be monitored annually in lower risk patients but up to every three to six months in higher risk patients (see box 1). Additional monitoring may be required after dose increases, if interacting drugs (Table 3) are added and during illness. People with hypertension taking diuretics should have their electrolytes assessed within four to six weeks of initiating therapy and thereafter can be assessed every six to twelve months unless their clinical condition changes or a potentially interacting drug is added (Table 3). Spironolactone can cause hyperkalaemia and requires close monitoring initially Drugs taken concurrently with spironolactone may also increase the risk of hyperkalaemia. These include NSAIDs, ACE inhibitors and cyclosporin (see Table 3). Patients should be advised to avoid use of over-the-counter NSAIDs and herbal products that contain potassium and advised to avoid foods rich in potassium such as bananas, orange juice and melons and to avoid use of salt substitutes or other products that contain potassium.3,4 Close attention to medication regimens, particularly for patients with heart failure, is required in situations where blood volume changes or electrolyte disturbances occurOne example is vomiting and diarrhoea due to gastroenteritis or food poisoning. In this situation,
A simple management strategy is to withhold medications with serial assessments including both volume status (weight, level of hydration) and blood results. This is particularly important for people with heart failure. Thiazide and loop diuretics can cause hyponatraemia and hypokalaemiaThiazide and loop diuretics both cause hyponatraemia and hypokalaemia, however thiazide diuretics are more often associated with hyponatraemia. Hypokalaemia may increase the risk of arrhythmias and is a particular problem for people also taking digoxin due to the increased risk of toxicity.1 Box 2: NYHA status: Severity based on symptoms and physical activityClass I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnoea. Class II: Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, or dyspnoea (symptomatically ‘mild’ heart failure). Class III: Marked limitation of physical activity. Although comfortable at rest, less than ordinary physical activity results in fatigue, palpitation, or dyspnoea (symptomatically ‘moderate’ heart failure). Class IV: Inability to carry out any physical activity without discomfort. Symptoms of congestive cardiac failure are present even at rest. With any physical activity, increased discomfort is experienced (symptomatically ‘severe’ heart failure). Assess electrolytes and renal function in patients whose clinical condition changesHyponatraemia can occur even after prolonged treatment and more commonly occurs in elderly people. Lethargy, dizziness or vomiting may be a sign of hyponatraemia and it is recommended that any patient presenting with these symptoms should have their electrolytes and renal function measured.2 Note: sodium levels slightly below the reference range can occur in the absence of symptoms. It is more important to look for changes in sodium levels and symptoms rather than isolated measurements. Other drugs may increase the risk of adverse effectsAdditional monitoring may be required when other drugs are added to current diuretic therapy. Other medicines that effect renal function or electrolyte status may increase the risk of adverse events occurring. Diuretic drug interactions are described in Table 3. Table 1: Recommended monitoring for diuretics in hypertension2,5
Table 2: Recommended monitoring for diuretics in heart failure2,5
Table 3: Drug interactions with diuretics6,7
References
What should be monitored when taking hydrochlorothiazide?While the drug is relatively safe, the patient's electrolyte status has to be monitored regularly. Even though hydrochlorothiazide has been the most widely used thiazide drug for hypertension, more recent evidence indicates that it may not be as effective as some of the other thiazide diuretics.
What are the side effects of hydrochlorothiazide?Advertisement. Back, leg, or stomach pains.. black, tarry stools.. blistering, peeling, or loosening of the skin.. blood in the urine or stools.. blue lips and fingernails.. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings.. chest pain or tightness.. cloudy urine.. Can hydrochlorothiazide cause hypokalemia?Hydrochlorothiazide affects electrolyte and fluid balance in the body, which can have serious side effects. This medication may cause low sodium levels (hyponatremia), low potassium levels (hypokalemia), and low magnesium levels (hypomagnesemia).
What are the contraindications for hydrochlorothiazide?Contraindications / Precautions. General Information. ... . Asthma, penicillin hypersensitivity, sulfonamide hypersensitivity, thiazide diuretic hypersensitivity. ... . Hepatic disease. ... . Diabetes mellitus, hyperglycemia. ... . Anuria, hypovolemia, renal disease, renal failure, renal impairment.. |