DIURETICS-LOOP DIURETICS

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SUMMARY

1. They remain effective when GFR is low (CrCl < 20 cc/min), but you have to increase the dose and/or give IV. Quite powerful: excretion of 20 to 25% of filtered sodium.

2. Inhibit the Na+/2CI-/K+ co-transporter & prevent reabsorption of Na+ in the thick ascending segment of Loop of Henle.

3. Hence, prevents development of the interstitial osmotic gra­dient, relied upon by the thin descending segment for water reabsorption.

4. The net effect is loss of both Na+ & water.

5. K+ is co-transported by the pump that is inhibited by loop diuretics, leading to hypokalemia.

6. Loop diuretics also increase Ca+ loss in the urine. Potential concern of nephrocalcinosis.


Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].