REFRACTORY EDEMA IN CONGESTIVE-HEART-FAILURE - A CONTRIBUTORY ROLE OFLOOP DIURETICS

We report a patient with congestive heart failure (CHF) who presented with massive oedema resistant to therapy with maximal doses of loop di uretics, despite an adequate renal function. After a diuretic pause an d dietary salt restriction, a conventional dose of furosemide in combi nation with distally active diuretics induced a prompt weight loss exc eeding 30 kg with stable renal function. We suggest that the 'refracto ry' oedema in this patient was due to a combination of CHF and inappro priate (loop) diuretic therapy in conjunction with a high dietary sodi um intake. We conclude that in the absence of hyponatraemia and renal failure, even severe oedema may not represent a negative prognostic in dicator. The recognition of diuretic-associated mechanisms complicatin g cardiac oedema is essential to avoid the vicious circle of worsening oedema whilst escalating therapy with loop diuretics.