Metabolic alkalosis amiloride

Electrolyte imbalance and BUN increases Hyponatremia and hypochloremia may occur when amiloride is used with other diuretics. Increases in BUN levels usually accompany vigorous fluid elimination, especially when diuretic therapy is used in seriously ill patients, such as those who have hepatic cirrhosis with ascites and metabolic alkalosis, or those with resistant edema. 

Patients with congenital nephrogenic diabetes insipidus are often treated with a combination of a thiazide and a potassium-sparing diuretic, without consensus on the preferred potassium-sparing diuretic. A Japanese adult was systematically studied to determine the renal effects of hydrochlorothiazide plus amiloride and hydrochlorothiazide plus triamterene (1). The combination with amiloride was superior to that with triamterene in preventing excessive urinary potassium loss, hjrpokalemia, and metabolic alkalosis. These results suggest that amiloride is the preferred add-on therapy to hydrochlorothiazide in nephrogenic diabetes insipidus. 

Amiloride (Midamor) Directly increases Na+ excretion and decreases K+ secretion in distal convoluted tubule. Used with other diuretics because K+-sparing effects lessen hypokalemic effects. May correct metabolic alkalosis. HYPERkalemia, sodium or water depletion. Patients with diabetes mellitus may develop glucose intolerance. 

---