Diuretic-induced

Aimstrong, L.E., Costill, D.L., Fink, W.J. (1985). Influence of diuretic-induced dehydration on competitive running performance. Med. Sci. Sports Exerc. 17,456-461. 

Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors not only cause vasodilation (1 TPR), but also inhibit the aldosterone response to net sodium loss. Normally, aldosterone, which enhances reabsorption of sodium in the kidney, would oppose diuretic-induced sodium loss. Therefore, coadministration of ACE inhibitors would enhance the efficacy of diuretic drugs. 

In metabolic alkalosis and respiratory acidosis, pH does not usually deviate significantly from normal, but treatment can be required to maintain Pao2 and PaC02 at acceptable levels. Treatment should be aimed at decreasing plasma bicarbonate with sodium and potassium chloride therapy, allowing renal excretion of retained bicarbonate from diuretic-induced metabolic alkalosis. 

In order to correct potassium losses and the consequent diuretic-induced hypokalemia, spironolactone or triamterene can be successfully combined with the thiazide, metolazone, chlorthalidone, furosemide or ethacrynic acid. 

Diuretics - Generally initiate therapy with a thiazide or other oral diuretic. Thiazide-type diuretics are drugs of choice hydrochlorothiazide or chlorthalidone are generally preferred. Reserve loop diuretics for selected patients. This therapy alone may control many cases of mild hypertension. Consider treating diuretic-induced hypokalemia (less than 3.5 mEq/L) with potassium supplementation or by adding a potassium-sparing diuretic to therapy. 

Children-A dose of 1 to 2 mg/kg twice/day has been recommended. Hypokalemia 25 to 100 mg/day. Useful in treating diuretic-induced hypokalemia when oral potassium supplements or other potassium-sparing regimens are considered inappropriate. 

Diuretic-induced metabolic alkalosis is another adverse effect that may further compromise cardiac function. This complication can be treated with replacement of K+ and restoration of intravascular volume with saline however, severe heart failure may preclude the use of saline even in patients who have received excessive diuretic therapy. In these cases, adjunctive use of acetazolamide helps to... 

Achyranthes asperia L. var. indica L. Tu Niu Teng (Prickly chaff flower) (seed) Beta-carotene, thiamine, riboflavin, niacin, saponins, ascorbic acid, protein.50 Antispasmodic, diuretic, induce labor, antifertility, antiinflammatory. 

Well-conducted studies have shown that diuretic-induced changes in serum uric acid are dose-related (344,356). In low-dosage regimens, as currently recommended, alterations are minor, and other than the risk of gout the long-term consequences of an increased serum uric acid are unknown. 

Diuretic-induced effects on lipid metabolism are dose-related (344,345) at low dosages of thiazides, changes are very slight while antihypertensive efficacy is well maintained. Diuretic-induced lipid changes have not been prominent in studies lasting one year or longer (364,365,359,362,366). An association between thiazide use or antihypertensive treatment and changes in serum lipids has been shown in some population surveys (367,368) but not in others (369). 

A woman with a 2-week history of insomnia took zopiclone 7.5 mg nightly and over the next 9 days became confused, lethargic, and depressed, culminating in an overdose of six zopiclone tablets. Her previous medical history included hypertension and two episodes of diuretic-induced SIADH. Her serum sodium was 129 mmol/1 and 4 days later fell to 113 mmol/1. Her serum osmolality was low (240 mmol/kg) and her urine sodium was 20 mmol/1. The serum sodium returned to normal 12 days after withdrawal of zopiclone. 

Kaplan NM. How bad are diuretic-induced hypokalemia and hypercholesterolemia Arch Intern Med 1989 149(12) 2649. 

Loop diuretics induce renal prostaglandin synthesis, and these prostaglandins participate in the renal actions of these drugs. NSAIDs (eg, indomethacin) can interfere with the actions of the loop diuretics by reducing prostaglandin synthesis in the kidney. This interference is minimal in otherwise normal subjects but may be significant in patients with nephrotic syndrome or hepatic cirrhosis. 

Angiotensin II and aldosterone levels Bladder and renal function Diuretic-induced stress test... 

Adverse effects Thiazide diuretics induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias (particularly individuals with left ventricular hypertrophy, ischemic heart disease, or chronic congestive heart failure) and who are concurrently being treated with both thiazide diuretics and digitalis glycosides (see p. 160). Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 

Fluid and sodium balance are important to the safe use of lithium. Both dehydration and a negative sodium balance (for example a low salt intake, diuretic-induced sodium loss) will reduce renal lithium clearance and predispose to toxicity (331). Hyponatremia (for example, secondary to polydipsia or SIADH) may also increase the risk of lithium toxicity (332). 

Diuretic-induced hypokalemia can potentiate thioridazine-induced cardiotoxicity (10). 

Thiazide diuretic-induced hyponatremia is much more common in older than in younger patients, probably due to thiazide-mediated impairment in renal diluting capacity superimposed on the already present age-related decrease in capacity to dilute urine. Older studies indicated this was an extremely common cause... 

Fichman M, Vorherr H, Kleeman G. Diuretic-induced hyponatremia. Ann Intern Med 1971 75 853-63. 

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