Diuretics: Adverse effects


Loop and thiazide diuretics  can cause metabolic alkalosis due to increased excretion of chloride in proportion to bicarbonate.  This is more common with loop diuretics than thiazide diuretics.  They can also can cause hypokalemia, hyperglycemia and glucose intolerance, hyperlipidemia, hyponatremia, hyperuricemia, hypomagnesemia.  Thiazide diuretics can cause hypercalcemia while loop diuretics increase the excretion of calcium which can lead to hypocalcemia.  Moreover, loop and thiazide diuretics are sulfonamides and can lead to allergic reactions.  Loop diuretics also have the potential to cause ototoxicity and hearing loss.  Of note hypokalemia can cause ventricular arrhythmias and muscular weakness.

Acetazolamide is a sulfonamide and can lead to allergic reactions.   Other adverse reactions include paresthesias, tinnitus, taste alteration, and metabolic acidosis (especially in elderly and kidney disease).

Mannitol has complex effects on electrolytes.  It initially leads to hypertonic hyponatremia when it recruits water from cells.  Later as the extracellular fluid is excreted, hyperkalemic acidosis can develop.  After this hypernatremic dehydration may occur.


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