Never knew this before and no cardiologist or nephrologist has ever mentioned this to me as far as management goes. Read this on uptodate on the article "Causes and treatment of refractory edema in adults": Benefit from a supine posture — Diuretic responsiveness can be influenced by posture, although the effects of posture have not been specifically studied in patients with refractory edema. Patients with heart failure, for example, cannot increase cardiac output normally with assumption of an upright position. As a result, kidney perfusion and presumably urinary diuretic delivery further diminish. In addition, renal salt and water reabsorption increase. The efficacy of assuming a supine position was evaluated in a randomized trial of six patients with heart failure and six with cirrhosis and ascites [59]. After staying in bed overnight, the patients were treated with 1 mg of bumetanide IV and then assigned to either continued bed rest or normal daily activity for the next six hours. The procedure was repeated two days later when each patient was assigned to the opposite group. The supine position was associated with higher mean creatinine clearance (100 versus 66 mL/min) and diuretic response (1133 versus 626 mL at six hours). The upright position was associated with significant increases in plasma norepinephrine, renin, and aldosterone. Has anyone used this principle to augment diuresis in their patients? I would think that putting the already immobile anasarca patient in a bedbound/supine position isn't going to be beneficial in the long-run if they're going to get deconditioned by the time of their discharge.   submitted by   /u/princetonwu [link]   [comments]