Diuretics of choice for acute pulmonary edema –
**Core Concept**
Diuretics are a crucial class of medications used to treat acute pulmonary edema by promoting the excretion of excess fluid from the body. The ideal diuretic for this condition should act quickly, have a potent effect, and be able to alleviate symptoms effectively.
**Why the Correct Answer is Right**
The diuretic of choice for acute pulmonary edema is loop diuretics, specifically furosemide. This is because loop diuretics act by inhibiting the sodium-potassium-chloride cotransporter (NKCC2) in the thick ascending limb of the loop of Henle, leading to increased excretion of sodium, chloride, and water. Furosemide is administered intravenously, which allows for rapid onset of action and effective reduction in pulmonary congestion.
**Why Each Wrong Option is Incorrect**
**Option A:** Thiazide diuretics, such as hydrochlorothiazide, are less potent and have a slower onset of action compared to loop diuretics, making them less suitable for acute pulmonary edema.
**Option B:** Potassium-sparing diuretics, such as spironolactone, are not effective in acute settings due to their slow onset of action and may even worsen hypokalemia.
**Option C:** Osmotic diuretics, such as mannitol, are not typically used for pulmonary edema as they can increase intracranial pressure and have limited diuretic effect.
**Clinical Pearl / High-Yield Fact**
In acute pulmonary edema, loop diuretics like furosemide should be administered as a bolus injection, typically 40-80 mg IV, and repeated as needed to achieve the desired effect.
**Correct Answer: C. Furosemide**