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Loop Diuretics and Electrolyte Imbalances

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Loop Diuretics and Electrolyte Imbalances

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Questions and Answers

Loop diuretics can cause __________ that manifests as tinnitus, hearing impairment, deafness, vertigo, and a sense of fullness in the ears.

ototoxicity

Loop diuretics should be avoided in postmenopausal osteopenic women, in whom increased Ca2+ excretion may have deleterious effects on _______ metabolism.

bone

Increased Na+ delivery to the distal tubule, particularly when combined with activation of the renin– angiotensin system, leads to increased urinary K+ and H+ excretion, causing a __________ alkalosis.

hypochloremic

What are some of the adverse effects of overzealous use of loop diuretics?

Serious depletion of total-body Na+, hyponatremia, extracellular fluid volume depletion, hypotension, reduced GFR, circulatory collapse, thromboembolic episodes, hepatic encephalopathy, hypochloremic alkalosis, hypokalemia, cardiac arrhythmias, hypomagnesemia, hypocalcemia, ototoxicity, hyperuricemia, hyperglycemia, increased plasma levels of LDL cholesterol and triglycerides while decreasing plasma levels of HDL cholesterol, skin rashes, photosensitivity, paresthesias, bone marrow depression, and GI disturbances. Signup and view all the answers

What are the contraindications to the use of loop diuretics?

Severe Na+ and volume depletion, hypersensitivity to sulfonamides (for sulfonamide-based loop diuretics), and anuria unresponsive to a trial dose of loop diuretic. Signup and view all the answers

What drug interactions may occur when loop diuretics are coadministered with other medications?

Aminoglycosides, carboplatin, paclitaxel, and others (synergism of ototoxicity), anticoagulants (increased anticoagulant activity), digitalis glycosides (increased digitalis-induced arrhythmias), lithium (increased plasma levels of Li+), propranolol (increased plasma levels of propranolol), sulfonylureas (hyperglycemia), cisplatin (increased risk of diuretic-induced ototoxicity), NSAIDs (blunted diuretic response and salicylate toxicity with high doses of salicylates), probenecid (blunted diuretic response), thiazide diuretics (synergism of diuretic activity of both drugs, leading to profound diuresis), and amphotericin B (increased potential for nephrotoxicity and intensification of electrolyte imbalance). Signup and view all the answers