Use of Modern Diuretics

T HE USE OF DIURETICS was revolutionized some 6 or 7 years ago by the introduction of chlorothiazide, the first satisfactorily effective orally administered diuretic. The fact that at least two far more potent diuretics, also effective on oral administration, are probably close to release for general use' 2 makes it appropriate to take stock of the present situation and to consider the prospective benefits and dangers which may be anticipated from the widespread and possibly indiscriminate application of such powerful diuretic agents. By its general definition, diuresis is any increase in urine flow. With respect to the purposes for which diuretics are useful, this definition is far too broad and can lead to misguided application. We will consider a diuretic agent to be one which can produce a negative balance of sodium by increasing the excretion of salt by the kidney. The ability to produce a negative balance is important since, for example, the administration of salt itself will generally increase sodium excretion by the kidney; this hardly conforms, however, to the purposes for which diuretics are generally used.