Acidotic diuretics

The acidotic diuretics are essentially the inorganie eompoimds having a eation funetion. Examples are-ammonium or calcium, combined with a fixed anion viz., chloride ion, which causes two vital, actions, namely systemic hyperchloremic acidosis and weak diuretic effect. These eompoimds e.g., ammonium chloride, calcium chloride) invariably potentiate the diuretic action of mercurial diuretics and hence may be administered at least 48-72 hours prior to the treatment of a mercurial compound so as to facilitate hyperehloremic acidosis. Recently, insoluble cation exchange resins have been used to act as diuretics by this mechanism. 

Ammonium chloride causes diuresis by inducing mild acidosis. The acid-forming propert is due to the conversion of NH4 ion to urea, which leaves the d ion free to combine with the available eation, liberated from the elastic HCO3 ion. This eventually upsets the BHCO3 H2CO3 ratio thereby eausing acidosis, thus  

The net result in that Cl ion displaced HC03 ion and the latter is converted to CO2. This phenomenon appreciably enhances the Cl load to the kidneys thereby allowing a substantial amount of it to escape imabsorbed with a matching amount of Na ion along with an isoosmotic amoimt of water. The overall effect being the net loss of extracellular fluid thereby helping the mobilization of oedema fluid. 

There are a few potent diuretics which could not be accommodated conveniently into any of the classifications made so far (A-I), hence they have been grouped together under this head. 

Triamterene is usually recommended in the treatment of oedema associated with nephrotic syndrome, cirrhosis of liver, and congestive heart failure. It has also been used for the control and management of idiopathic oedema, steroid-induced oedema, oedema caused by hyperaldosteronism and in such oedematus patients who fail to respond to other therapy. It is usually used in conjunction with other diuretics like thiazides. 

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Diclofenamide is employed to lower intraocular pressure by reducing the rate of secretion of aqueous humor. It is recommendedfor the treatment of both primary and secondary glaucoma. Though it possesses inherent diuretic properties it is not promoted for this purpose. It produces less acidotic refractoriness to diuretic action than acetazolamide. 

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