Diuretics have glucose-elevating effects, and may not be suitable in cases of diabetes mellitus. Diuretics compete with uric acid for secretion in the proximal tubule, so a build-up uric acid may occur leading to hyperuricaemia and gout Downie, Caution is advised in patients with liver disease, which may interfere with drug metabolism and lead to toxicity. The elderly may be more susceptible to the side-effects, and lower doses are advised initially. Some diuretics thiazides and loop diuretics are known to cross the placenta and others have been associated with fetal abnormalities: they are not recommended in pregnancy unless benefits to the mother outweigh the potential effects on the fetus Karch, Find out about fluid balance in our urea and electrolytes section.
Downie, G. Edinburgh: Churchill Livingstone. Hopkins, S. Karch, A. Philadelphia, Pa: Lipincott, Williams and Wilkins. Woodrow, R. New York: Delmar. Sign in or Register a new account to join the discussion.
You are here: Medicine management. Diuretic drugs. Carol McLoughlin Diuretics are drugs used to increase the amount of urine produced by the kidneys and increase the excretion of sodium and other electrolytes Karch, KEY POINTS Diuretics are drugs that increase the excretion of sodium and therefore water from the kidneys They are used to relieve oedema associated with congestive heart failure, liver and renal failure, and as adjuncts to antihypertension medication Classes of diuretics differ in their site of action in the renal nephrons and in intensity of effect Caution is required in conditions exacerbated by changes in fluid and electrolyte balance Adverse effects include electrolyte imbalance, hypotension, hypovolaemia, hypoglycaemia and metabolic alkalosis Patients receiving diuretics need to be monitored for fluid loss and retention, and electrolyte imbalance.
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Indications The primary indications for the use of mannitol include: Increased ICP due to: Cerebral edema Brain masses Increased intraocular pressure e. Use with caution in pregnancy and lactation. Comparison of Medications Some of the other most common diuretics include thiazide diuretics e. The sites of action within the nephron for the diuretic drug classes Image by Lecturio.
References Lexicomp drug topic pages: mannitol systemic. Diuretic agents. In Katzung, B. Basic and Clinical Pharmacology, 12th ed. Mesghali, E. J Emerg Med — A comparison of pharmacologic therapeutic agents used for the reduction of intracranial pressure after traumatic brain injury.
World Neurosurg — Hypertonic saline for increased intracranial pressure after aneurysmal subarachnoid hemorrhage: a systematic review. World Neurosurg —6. Mannitol for acute traumatic brain injury. Effect of mannitol on the globe and orbital volumes in humans. Eur J Ophthalmol — Preservation of blood pressure stability with hypertonic mannitol during hemodialysis initiation. Am J Nephrol — Osmotic opening of the blood-brain barrier: principles, mechanism, and therapeutic applications.
Cell Mol Neurobiol — Along the proximal tubules, net osmotic force is progressively reduced as mannitol concentration rises, accounting for reduced water and sodium chloride reabsorption. Abstract Mannitol might inhibit paracellular reabsorption of water and sodium chloride in the proximal tubules by reducing the osmotic driving force.
Publication types Research Support, Non-U.
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