Pee pee. The best feeling when you have a full bladder. The annoyance when your dog is overdrinking because of a medication and can’t wait to go outside. The desire when one’s prostate is enlarged and won’t allow the flow to flow. The necessity when a heart is overloaded…preloaded, to be more precise.
When a patient is admitted with fluid overload, every prescriber has a comfort level on how to treat it. There are usual types and ranges of doses of diuretics, guidelines, and experience. Some prescribers have favored strategies, and some will get a consult from a specialist.
Regardless of the tactic, there is science behind it all. Very clear concepts guide the use of diuretics. However, a lot of people just observe and emulate, not knowing the why or when or how of it all.
The problem is not everyone gets the science. Enter PHARMACOLOGY.
Today I heard, “On a patient last week, Dr. D ordered Drug P at 100mg and the patient peed a lot. So, I thought we should do the same thing for this patient. He’s only on 40mg of Drug J, but Drug P is so much more potent. If we give a more potent drug at a higher dose, I’m thinking we’ll have a much faster pee pee for this patient.” I’m paraphrasing.
Again, the problem? This is not how diuretics work. In short, there is a maximum dose of sorts. And it’s different for every patient. A higher dose will not achieve a greater effect. There’s also a dose too low to be effective, and that’s also different for every patient. You have to find the right dose to cause the pee.
So, what would happen if Drug P at 100mg was ordered? You’d probably make the patient pee pee. But you could also cause a lot of other problems. First, do no harm, right? Besides, Drug J is working at its 40mg dose, and our current patient is different from last week’s patient.
This reminds me of my mom’s gourds. She’s an artist. A hobbyist who doesn’t get properly reimbursed for her talents…and skills. She’s like the consultant. If someone needs something artistic, they call her.
She paints gourds. People love her gourds. People want to learn how to paint gourds just like hers. People ask for tutorials. And my mom teaches them for the joy of it. That’s it. No pay. Her gourds are truly a work of art.
When the ladies who beg my mom to teach them how to paint gourds try to paint their own, the result is amateur, like an arts and crafts project from summer camp. They are rough and bumpy, lack the mingling lines of color, and do not have the same mirror-like finish.
They tried to emulate my mom’s carefully created product without employing her intentionally ordered process. They didn’t see the importance, or perhaps didn’t understand it, of the intermediary steps that made the gourds smooth and expert.
Her art has a method. It has a science. Enter the ARTIST.
They say imitation is the sincerest form of flattery, but it’s not really. When the result is poorly executed, it is insulting. Frankly, no one wants to be associated with it. When the patient is readmitted for complications of the diuretics, it’s aggravating. I back up slowly, hands up in feigned ignorance, turn on my heel, and exit the room…probably to got to the bathroom…to pee pee.