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Diuretic
Aka: Diuretic, Sulfa-based Diuretic, Hypokalemia in Diuretic Use, Prevention of Diuretic-Induced Hypokalemia
- See Also
- Sodium and Water Homeostasis
- Indications
- Common Indications
- Congestive Heart Failure
- Hypertension
- Chronic Kidney Disease
- Cirrhosis
- Other specific indications
- Acute Glaucoma
- Increased Intracranial Pressure (Mannitol)
- High Altitude Sickness (Acetazolamide)
- Preparations
- Thiazide Diuretics
- Loop Diuretics
- Potassium-Sparing Diuretics
- Sulfonamide Diuretics: Metolazone (Zaroxolyn)
- Preparations: Related to Sulfa-base
- Hypersensitivity to Sulfonamide antibiotics does not confer other sulfa-based agent allergy
- May be safe to trial on sulfa-based agent despite prior sulfa antibiotic reaction
- Anaphylaxis to sulfa agent in past contraindicates repeat sulfa trial
- Strom (2003) N Engl J Med 349: 1628-35 [PubMed]
- Sulfa-based Diuretics
- Furosemide
- Torsemide
- Bumetanide
- All Thiazide Diuretics
- Non-sulfa based agents
- Potassium-Sparing Diuretics (e.g. Triamterene, Spironolactone, Amiloride)
- Ethacrynic Acid
- Prevention: Hypokalemia in Diuretic Use
- See Potassium Replacement
- See Hypokalemia
- Monitoring
- Serum Potassium
- Obtain at baseline
- Repeat weekly when initiating high potency Diuretics (esp. Loop Diuretics, multiple Diuretics)
- Obtain periodically when stable on longterm Diuretics
- Every 3-4 months and as needed on high potency diurectics
- Every 6-12 months on Hydrochlorothiazide or Chlorthalidone
- Serum Magnesium
- Obtain at baseline and as needed for significant Hypokalemia
- Magnesium Replacement as needed
- Optimize concurrent medications that increase Serum Potassium
- ACE Inhibitors or Angiotensin Receptor Blockers
- Spironolactone
- Schedule Potassium Supplementation
- Adjust Potassium dose based on Diuretic dose and potency, Renal Function and baseline Serum Potassium
- Start Potassium chloride 20 meq orally daily when on Loop Diuretics
- Increase Potassium dosing as needed at times of increased Diuretic dosing
- When doubling the Diuretic dose, also double the Potassium chloride to 40 meq/day
- Monitor Potassium closely (weekly) after adjusting Diuretic and Potassium dosing
- References
- (2021) Presc Lett 28(8): 44
- Ferreira (2020) J Am Coll Cardiol 75(22):2836-50 +PMID: 32498812 [PubMed]