Diuretics
Diuretics
Diuretics
Contents
[hide]
1 Types
o 1.1 High ceiling loop diuretics
o 1.2 Thiazides
o 1.3 Digitalis
o 1.4 Potassium-sparing diuretics
o 1.5 Calcium-sparing diuretics
o 1.6 Osmotic diuretics
o 1.7 Low ceiling diuretics
2 Uses
3 Mechanism of action
4 Adverse effects
5 See also
6 References
7 External links
[edit] Types
[edit] High ceiling loop diuretics
High ceiling diuretics are diuretics that may cause a substantial diuresis up to 20%[1]
of the filtered load of NaCl and water.This is huge when compared to normal renal
sodium reabsorption which leaves only ~0.4% of filtered sodium in the urine.
Loop diuretics have this ability, and are therefore often synonymous with high ceiling
diuretics. Loop diuretics, such as furosemide, inhibit the body's ability to reabsorb
sodium at the ascending loop in the kidney which leads to a retention of water in the
urine as water normally follows sodium back into the extracellular fluid (ECF). Other
examples of high ceiling loop diuretics include ethacrynic acid, torsemide and
bumetanide.
[edit] Thiazides
Thiazide-type diuretics such as hydrochlorothiazide act on the distal convoluted
tubule and inhibit the sodium-chloride symporter leading to a retention of water in the
urine, as water normally follows penetrating solutes. Frequent urination is due to the
increased loss of water that has not been retained from the body as a result of a
concomitant relationship with sodium loss from the convoluted tubule. The short-term
anti-hypertensive action is based on the fact that thiazides decrease preload,
decreasing blood pressure. On the other hand the long-term effect is due to an
unknown vasodilator effect that decreases blood pressure by decreasing resistance.
[edit] Digitalis
Digitalis has a diuretic effect on heart failure patients. [add more info]
[edit] Uses
In medicine, diuretics are used to treat heart failure, liver cirrhosis, hypertension and
certain kidney diseases. Some diuretics, such as acetazolamide, help to make the urine
more alkaline and are helpful in increasing excretion of substances such as aspirin in
cases of overdose or poisoning. Diuretics are often abused by sufferers of eating
disorders, especially bulimics, in attempts at weight loss.
The antihypertensive actions of some diuretics (thiazides and loop diuretics in
particular) are independent of their diuretic effect. That is, the reduction in blood
pressure is not due to decreased blood volume resulting from increased urine
production, but occurs through other mechanisms and at lower doses than that
required to produce diuresis. Indapamide was specifically designed with this in mind,
and has a larger therapeutic window for hypertension (without pronounced diuresis)
than most other diuretics.
Examples
Mechanism
Location
(numbered in
distance along
nephron)
Ethanol, Water
1.
1.
inhibit
amphotericin B,
5. collecting
Arginine vasopressin
vasopressin's
lithium citrate
duct
receptor 2 antagonists
action
Increases blood
Goldenrod, Juniper
1.
Aquaretics
flow in kidneys
2. proximal
promote Na+
Na-H exchanger antagonists dopamine[8]
excretion
tubule[8]
inhibit H+
secretion,
2: proximal
Carbonic anhydrase inhibito acetazolamide[8],
resultant
dorzolamide
rs
+ tubule
promotion of Na
and K+ excretion
bumetanide[8],
3. medullary
ethacrynic acid[8], inhibit the Na-Kthick
Loop diuretics
furosemide[8],
2Cl symporter
ascending limb
torsemide
2. proximal
glucose (especially
promote osmotic tubule,
in uncontrolled
Osmotic diuretics
diuresis
descending
diabetes), mannitol
limb
inhibition of
Na+/K+
exchanger:
amiloride,
Spironolactone
spironolactone,
5. cortical
inhibits
collecting
Potassium-sparing diuretics triamterene,
aldosterone
potassium
ducts
action, Amiloride
canrenoate.
inhibits epithelial
sodium
channels[8]
inhibit
bendroflumethiazid
4. distal
reabsorption by
e,
convoluted
Thiazides
Na+/Clhydrochlorothiazide
tubules
symporter
inhibit
caffeine,
reabsorption of
theophylline,
Na+, increase
1. tubules
Xanthines
theobromine
glomerular
filtration rate
Acidifying salts
CaCl2, NH4Cl
inhibits
vasopressin
secretion
Chemically, diuretics are a diverse group of compounds that either stimulate or inhibit
various hormones that naturally occur in the body to regulate urine production by the
kidneys. Herbal medications are not inherently diuretics. They are more correctly
called aquaretics.
effect
Symptoms
lassitude[8]
thirst[8]
muscle cramps[8]
hypotension[8]
loop diuretics
thiazides[8]
acetazolamides[8]
loop diuretics[8]
thiazides[8]
muscle weakness[8]
paralysis[8]
arrhythmia[8]
amilorides[8]
triamterenes[8]
spironolactone[8]
arrhythmia[8]
muscle cramps[8]
paralysis[8]
thiazides[8]
furosemides[8]
hyponatremia
CNS symptoms[8]
[8]
o coma
metabolic alkalosis
loop diuretics[8]
thiazides[8]
arrhythmia[8]
CNS symptoms[8]
Kussmaul respirations[8]
muscle weakness
neurological symptoms[8]
o lethargy
o coma
o seizures
o stupor
gout
tissue calcification[8]
fatigue
depression
confusion
anorexia
nausea
Hypovolemia
hypokalemia
Hyperkalemia
metabolic acidosis
hypercalcemia
[8]
acetazolamides[8]
amilorides[8]
triamterene[8]
thiazides[8]
hyperuricemia
thiazides[8]
loop diuretics[8]
vomiting
constipation
pancreatitis
increased urination
gout[8]