The relationship between the intracanular concentrations of unbound (free) furosemide and its natriuretic effect is in the form of a sigmoid curve with a minimum effective furosemide excretion rate of about 10 g / min. Therefore, prolonged infusion of furosemide is more effective than repeated bolus administration. In addition, if a certain bolus dose is exceeded, no significant increase in the effect is observed. When the tubular secretion of furosemide decreases or when the drug binds to the albumin located in the lumen of the tubules (for example, in a nephrotic syndrome), the effect of furosemide decreases.
Charlotte Larkin (Risk: High) - Suicide & FaithSuicide & Faith

Faith Member Background

Charlotte Larkin (Risk: High)

Charlotte LarkinCharlotte Larkin, a 48-year-old Caucasian female, has just joined a new Episcopal church. Her only daughter, 17-year-old Marie, graduated from high school in the spring and has just moved across the country for college.

With her daughter striking out on her own, Charlotte finds herself flashing back to her late teens. Her mother passed away when she was very young, so her father raised her single-handedly, with the help of their church, despite the challenge of his own undiagnosed depression. While they had a close relationship, she also felt depressed and unsafe at home and, after a depressive episode, she ran away at 15. She lived in shelters and occasionally on the streets until she managed to find a roommate and get into a community college. She only reconnected with her father at 17. When she was 18, he died from cancer quite unexpectedly. Losing him in her second semester of school proved too hard a blow for Charlotte; she dropped out of school and fell into depression again, eventually attempting suicide with stolen Xanax.

Her roommate found her and forced her to go into treatment. After that crisis, she drifted for a while before finding real help and attaining improved function. She met Mark (now 52), her husband, about three months after finding a job and an apartment. Mark and Charlotte married almost immediately and had Marie within the year.

She and Mark both work full time and have since Marie was a toddler. Mark is only home one weekend a month, since he works offshore. Charlotte grew up Episcopal but found that work, childcare, and several recurrent bouts of depression (each lasting six months to a year each) left no time for church participation when Marie was growing up.

During Marie’s senior year, Charlotte began thinking about her own teenage years, especially some troubling moments with her uncle, her hard times as a homeless teen, the loss of her father, and her own suicide attempt. Charlotte entered another bout of depression, this one worse than any of her previous ones, and, as “empty nest” set in, she began quietly and increasingly reading up on “effective” ways to die by suicide.

Charlotte recently became a new member at a nearby Episcopal church. Returning to the rituals of her youth has triggered old memories and unexpected guilt and fears that she deprived Marie of a religious upbringing. She regrets that Marie missed out on the rituals and community Charlotte held dear as a child, and feels that she somehow failed her daughter. She’s been thinking a lot about religion and faith with the new spare time she has on her hands, and her recurring thoughts of suicide.

She’s in the minister’s office today because of new member protocol; after she joined on a whim during a service, the minister has asked to chat with her in his/her office.

Guarded Memories

From the time that Charlotte was 12 until she was 15, her uncle (her father’s only brother) sexually abused her. He lived close by and was one of the primary members of her small family’s support system, so she was often left alone with him. For the first two year, his intimidation coerced her into keeping the abuse a secret, but then, one Christmas, he abused her in a church classroom while her father was in a service.

After such trauma in the only location she still felt safe, she summoned the courage to tell her father what was happening. She can still remember the way his face flashed with anger, then hardened into silence. Not only did he refuse to believe her, he got angry at her for her “teenage dramatics” and disrespecting his only brother, who had done so much for them. He made her swear to never bring it up again.

Her performance in school dropped below acceptable levels, and she had to endure parent-teacher conferences where her father claimed to have no idea why she was doing so poorly. At 15, she could no longer take the abuse and neglect, and she ran away.