The Use and Abuse of Diuretics

Francisco, Linda L.

doi:10.1001/archinte.1982.00340140030008

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…Clinical signs and symptoms are usually non‐specific, and it is difficult to judge whether hyponatremia or the underlying disease is responsible. In the elderly, moderate hyponatremia (below 125 mmol/l) has been reported earlier and diuretics have been commonly implicated 4 , 7 . Dextrose infusions for fluid maintenance, undercorrection of gastrointestinal losses, untreated/undetected chest infection and overhydration in renal failure constitute other important underlying conditions.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia in elderly hospital in‐patients

Misra

Mansharamani

1989

Int J Clinical Practice

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Section: Discussionmentioning

confidence: 99%

Hyponatremia in elderly hospital in‐patients

Misra

Mansharamani

1989

Int J Clinical Practice

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“…1 They can be divided into different classes based on their sites of action. For example, loop diuretics and thiazides inhibit reabsorption of sodium and chloride in the Henle loop and distal tubule, respectively, thus leading to increased excretion of urine, whereas spironolactone and canrenoic acid act as competitive antagonists of aldosterone.…”

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confidence: 99%

“…Chronic abuse of these drugs can lead to many unwanted side effects such as hypokalemia, hypovolemia, hypotension, and collapse from sudden reduction of the extracellular fluid volume. 1 Increased blood viscosity increases the risk of thrombosis. Furthermore, hypokalemia may lead to life-threatening cardiac dysrhythmias.…”

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confidence: 99%

Screening Procedure for Detection of Diuretics and Uricosurics and/or Their Metabolites in Human Urine Using Gas Chromatography-Mass Spectrometry After Extractive Methylation

Beyer

Bierl

Peters

et al. 2005

Therapeutic Drug Monitoring

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A gas chromatography-mass spectrometry (GC-MS)-based screening procedure was developed for the detection of diuretics, uricosurics, and/or their metabolites in human urine after extractive methylation. Phase-transfer catalyst remaining in the organic phase was removed by solid-phase extraction on a diol phase. The compounds were separated by GC and identified by MS in the full-scan mode. The possible presence of the following drugs and/or their metabolites could be indicated using mass chromatography with the given ions: m/z 267, 352, 353, 355, 386, and 392 for thiazide diuretics bemetizide, bendroflumethiazide, butizide, chlorothiazide, cyclopenthiazide, cyclothiazide, hydrochlorothiazide, metolazone, polythiazide, and for canrenoic acid and spironolactone; m/z 77, 81, 181, 261, 270, 295, 406, and 438 for loop diuretics bumetanide, ethacrynic acid, furosemide, piretanide, torasemide, as well as the uricosurics benzbromarone, probenecid, and sulfinpyrazone; m/z 84, 85, 111, 112, 135, 161, 249, 253, 289, and 363 for the other diuretics acetazolamide, carzenide, chlorthalidone, clopamide, diclofenamide, etozoline, indapamide, mefruside, tienilic acid, and xipamide. The identity of positive signals in such mass chromatograms was confirmed by comparison of the peaks underlying full mass spectra with reference spectra. This method allowed the detection of the abovementioned drugs and/or their metabolites in human urine samples, except torasemide. The limits of detection ranged from 0.001 to 5 mg/L in the full-scan mode. Recoveries of selected diuretics and uricosurics, representing the different chemical classes, ranged from 46% to 99% with coefficients of variation of less than 21%. After ingestion of the lowest therapeutic doses, furosemide was detectable in urine samples for 67 hours, hydrochlorothiazide for 48 hours, and spironolactone for 52 hours (via its target analyte canrenone). The procedure described here is part of a systematic toxicological analysis procedure for acidic drugs and poisons.

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“…Severe hyponatremia (serum sodium level less than 125 mEq/l) has been reported in up to 4.5 per cent of elderly hospitalized patients and is often caused by excessive amounts of water 4,5 . Although hyponatremia may be caused by prolonged diuretic therapy, usually it is mild and clinically innocuous, and subsides with the cessation of the drug 6 . Stress, both physical and emotional, has long been known to affect renal water excretion, 7,8 but the effect is usually transient, and there are few well‐documented reports of severe hyponatremia produced by emotional stress alone.…”

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confidence: 99%

Severe Symptomatic Hyponatremia in Elderly Outpatients: The Role of Thiazide Therapy and Stress

Booker¹

1984

J American Geriatrics Society

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Severe symptomatic hyponatremia (serum sodium level 112 +/- 5.5 mEq/l) was encountered in six elderly outpatients within four days of the onset of thiazide therapy. Associated polydipsia was present in two of these patients, but the thiazides alone appeared responsible in the others. In three other elderly outpatients, severe hyponatremia (serum sodium level 112 +/- 5.25 mEq/l) developed after the acute emotional stress of relocation from their place of abode to a nursing home or hospital. Recurrent episodes of hyponatremia occurred in two patients following reinstitution of diuretic therapy, and, in two other patients, was precipitated by thiazides and stress on different occasions. Severe neurologic manifestations occurred in all patients and were mostly attributed to atherosclerotic dementia or stroke. Two patients died with severe hyponatremia, although all patients in whom cessation of thiazide therapy and water restriction were instituted promptly recovered without permanent sequelae.

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The Use and Abuse of Diuretics

Cited by 8 publications

References 25 publications

Hyponatremia in elderly hospital in‐patients

Hyponatremia in elderly hospital in‐patients

Screening Procedure for Detection of Diuretics and Uricosurics and/or Their Metabolites in Human Urine Using Gas Chromatography-Mass Spectrometry After Extractive Methylation

Severe Symptomatic Hyponatremia in Elderly Outpatients: The Role of Thiazide Therapy and Stress

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