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Previous Volume 336:295-296 January 23, 1997 Number 4 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: In his discussion of diuretic therapy in his excellent review of congestive heart failure (Aug. 15 issue),¹ Dr. Cohn did not mention that resistance to diuretics frequently develops in patients with severe refractory heart failure. The underlying mechanisms include decreased drug delivery to the nephron due to reduced renal blood flow, competition with organic acids for active secretion, compensatory sodium retention, hypochloremia, and decreased absorption of sodium due to edema of the gastrointestinal tract. Resistance can often be overcome by administering large intravenous doses or continuous infusions of diuretics. For example, furosemide, in doses of up to . . . [Full Text of this Article]

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