Spironolactone electrolyte balance

Hyperkalemia Carefully evaluate patients for possible fluid and electrolyte balance disturbances. Hyperkalemia may occur with impaired renal function or excessive potassium intake and can cause cardiac irregularities that may be fatal. Ordinarily, do not give potassium supplements with spironolactone. 

Other mineralocorticoids have an effect on the electrolytic balance of the body, but aldosterone is the most potent. Its ability to cause increased reabsorption of sodium and chloride ion and increased potassium ion excretion is approximately 3.000-fold that of hydrocortisone. A substance that antagonizes the effects of aldosterone could conceivably be a good diuretic drug. Spironolactone is such an antagonist. 

Electrolyte balance When 175 patients with resistant hypertension took spironolactone 25-100 mg/day adverse effects that were attributed to the drug included an acute reduction in renal function in two patients and asymptomatic hyperkalemia (serum potassium concentration over 5.5 mmol/1) in two patients spironolactone was withdrawn in these patients and in one patient, hyperkalemia resolved following a reduction in spironolactone dosage [25 ]. 

Electrolyte balance Hypernatremia has been reported in a 44-year-old woman with normal renal function who was given too much sodium polystyrene sulfonate she was also taking furosemide, spironolactone, and lisinopril [39 ]. The authors attributed this to net intestinal water loss because of profuse osmotic diarrhea. 

Electrolyte balance In a retrospective study of 2538 patients with newly diagnosed systolic HF, total of 521 patients who were started on spironolactone showed higher rates of severe hyperkalemia (4.8 vs 1.6 per 100 person-years, p < 0.001) compared with spironolactone nonuse patients. Overall, severe hyperkalemia occurred in 6.0% patients... 

Aspirin inhibits the renal effects of spironolactone on water and electrolyte balance, and inhibition of the active tubular secretion of the metabolite canienone has been postulated as a mechanism (152). 

---