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.
Kaden Akers (Risk: Low-Moderate) - Suicide & FaithSuicide & Faith

Faith Member Background

Kaden Akers (Risk: Low-Moderate)

Kaden AkersLife has been pretty good for Kaden Akers, 33-year-old African American male, over the last year. He has dealt with bipolar disorder since he was 16, which often manifested in binge eating and suicidal ideation. He kept these thoughts secret for years, humiliated by his thoughts in the midst of his faith’s strong taboo against suicide.

After a difficult bout of depression and a suicide attempt three years ago (he was hospitalized for days), he finally sought professional help. Since then, he has slowly found ways to manage his mental health and engage with the world around him. The minister at his church has been instrumental in supporting him as he learned how to live with depression and find ways to help himself, though he is still reticent to talk to other members about his issues.

Kaden was recently given a small raise at the national grocery store chain where he works, after having advocated for a promotion and being turned down several times due to the economy. He has occasional interpersonal conflicts with his coworkers, but he’s usually able to smooth them out with little lasting damage. Until very recently he was able to walk to work, which he enjoyed a great deal and found that it helped him clear his mind and lift his mood. After he was transferred to a new location because of his small promotion, his commute now puts him in a car in traffic for forty-five minutes twice a day. While he tries to deal with this change by stocking his car with his favorite CDs, the rush hour traffic sometimes triggers panic attacks and outbursts of road rage. He hasn’t told anyone about this.

After asking his friends to set him up on dates, he’s met Leena (35), a woman with whom he connects well, and they’ve just started dating.

Kaden does keep a heavy secret: if he were ever to return to that dark place, he would be too ashamed of having a relapse to ask for help again. After all the work and care that his minister gave him to help him deal with his mental health condition, he feels like it would be too humiliating to admit it if he ever felt suicidal again. It would be easier to just quietly wrap up the details of his life and end it, this time using a gun. He hasn’t told anyone about this plan; he keeps it secret and uses it almost as a calming mechanism on bad days.

Guarded Memories

When Kaden was 11, he and his single mother lived in a very small, predominantly Caucasian town. While there were a few kind classmates who befriended him, many of the students bullied him about being African American. Their methods ranged from verbal abuse to physical fights, from whispered threats to vandalism of his locker. When three of the bullying classmates followed him home and broke a window with a flaming baseball soaked in gasoline, his mother had no choice but to quit her job and move them in to her sister’s house 150 miles away.