Figure 146

Anasarca. Anasarca is a long-term management problem in diabetic nephropathy. As renal reserve decreases, the balance between volume overload and excessive diuresis may be difficult to maintain. Having the patient measure and record weight daily as a guide for each day's dose of diuretics (metolazone plus furosemide) is a workable strategy. Once the creatinine clearance falls below 10 mL/min, ambulatory dialysis may be the only means of continuing life outside the hospital.

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