INCIDENCE OF DIURETICS INDUCED ADVERSE DRUG REACTIONS IN AN INTENSIVE CARDIAC CARE UNIT OF A TERTIARY CARE TEACHING HOSPITAL

Objective: The present study was conducted to assess the incidence, causality and severity of diuretic induced Adverse Drug Reactions (ADRs). Method: 92 patients admitted in the intensive cardiac care unit and prescribed with diuretics were included and data on demographics, past medical and medication history, allergies to food/drugs, laboratory parameters, diuretics prescribed, side effects and ADRs were obtained. The causality of ADRs was assessed using Naranjo’s and WHO’s a causality assessment scale, the severity of ADRs using Hartwig and Siegel’s scale. Results: 41 (44.6%) patients were prescribed with one diuretic, 38(41.3%) with 2 diuretics and 13 (14.1%) with 3 diuretics. 54 patients were prescribed with loop diuretics, a combination of loop and potassium sparing diuretics were given for32 patients; loop and thiazides for 5 and a potassium sparing diuretic for one patient. Of 40 (44%) patients with ADRs, 32 had one ADR, 7 had two ADRs and one patient had three ADRs. Naranjo’s scale identified 25 ADRs as probable, 15 as Possible and none as unlikely or certain; WHO scale identified 22 ADRs as Possible and 18 as Probable. Hartwig’s and Seigel’s scale identified 28 ADRs as moderate, 09 as Mild and 03 as severe. Diuretics were continued for 30 patients and ADRs were managed by electrolyte replacement. Diuretics were withdrawn for 10 patients and potassium supplementation or a potassium sparing diuretic was given. Conclusion: This study suggests that diuretics induced ADRs could be minimized by early prediction of the symptoms developed by diuretics and assessing the laboratory abnormalities.