Hazards of Ethacrynic Acid

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To the Editor.— In the review article entitled "Acute Renal Failure" by Merrill (211:289, 1970), it is recommended that a test dose of ethacrynic acid as high as 200 mg be given to assist in determining the existence of prerenal failure. I feel that this procedure carries certain definite hazards. First, in a patient who may already have a volume depletion, additional fluid depletion after the administration of this highly potent diuretic may further compromise the marginally functional kidneys. Second, there are now a number of reported cases of both transient and possibly permanent deafness associated with the use of this diuretic in the presence of azotemia (Lancet1:41, 1969; Lancet1:77, 1969; andArch Intern Med11:715, 1966). Unless there are adequate data substantiating the value of the procedure, it is my feeling that the risks definitely outweigh the benefits of this therapeutic maneuver.

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