Plasma electrolytes in elderly patients taking fixed combination diuretics

Abstract

Summary:Plasma potassium and sodium concentrations were measured in a group ofelderly patients taking maintenance thiazide diuretic therapy alone, with a potassium supplement or in combination with a potassium sparing diuretic. Fixed dose combinations of a thiazide and potassium sparing diuretic did not significantly reduce the prevalence of hypokalaemia and the combination of amiloride-hydrochlorothiazide was associated with a disproportionate number of cases of hyponatraemia. The desirability of the current widespread use of fixed dose combination diuretics over less expensive single agents is questioned.

Metabolic Adverse Reactions to Diuretics Clinical Relevance to Elderly Patients

“…l23 ] Consequently, hypokalaemia should be corrected whether mild or severe, especially when there is a coexisting risk such as digitalis treatment, heart disease or glucose intolerance. [23] Potassium-sparing diuretics seem more efficient in raising potassium levels [23,28] and reducing the risk of sudden death [25] than potassium salts. However, if potassium salts are given, they should always be prescribed as potassium chloride (not gluconate), in the form of slow release tablets, so as to correct the chlorine deficiency and avoid intestinal toxicity.…”

“…They are nevertheless a matter of concern, as diuretics are often prescribed for older people, mainly for high blood pressure or cardiac insufficiency. For example, in a personal investigation among hospitalised people aged 70 years or more, 28.1 % were treated with a diuretic on admission.…”

Thiazide-Induced Hyponatremia

“…Hyponatremia is a common complication of thiazide diuretic therapy (1)(2)(3). Usually, the patient is asymptomatic, the degree of hyponatremia is modest and returns rapidly to normal on cessation of drug administration, water restriction, and potassium or magnesium supplementation (4,5).…”

Acetazolamide Attenuates Lithium–Induced Nephrogenic Diabetes Insipidus

“…[17][18][19][20] Moreover, initiating thiazide/amiloride treatment in patients with Li-NDI often leads to elevated blood lithium levels, necessitating adjustment of the lithium dose. 21 Therefore, to assess and compare the effect of acetazolamide and thiazide/amiloride on these parameters, we analyzed blood and urine for lithium and electrolyte levels (Table 1).…”