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What is a healthcare provider to do when a patient needs to have less fluid in his body? Diuretics to the rescue! Find out more about this important class of medications, its uses, and side effects, in this lesson.

Definition of Diuretics

Diuretics are a type of medication used to increase the amount of water released from the body in a patient’s urine. In fact, diuretics are commonly known as water pills.Now to explain how diuretics work, we are going to take a trip back in time to your 8th grade science class. Remember the term ‘osmosis?’ I bet you thought you would never need to use it, but this is exactly the principle upon which kidneys filter and diuretics work. Generally speaking, the process of osmosis goes like this: water naturally flows from an area of lower concentration to higher concentration making the overall solutions equal in concentration.

The kidneys are no different: they reabsorb electrolytes (mainly sodium, potassium and calcium). Due to osmosis, the water naturally follows the electrolytes to establish an equal concentration of solutes on either side of the semipermeable membrane in the kidney. So, what diuretics do is block the reabsorption of electrolytes. If the electrolytes are not reabsorbed into the body but stay in the urine, then voila! The water stays in the urine and is excreted as well, thereby, decreasing the amount of overall fluid in a patient.

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There are several reasons a healthcare provider may wish to decrease the overall volume of liquid in a patient, including high blood pressure, heart failure, edema (fluid retention), and liver or kidney disease.

Types ; Examples of Diuretics

There are three main types of diuretics. Each targets a different part of the kidneys and causes increased water excretion:1. Thiazide DiureticsThiazides are commonly used to treat high blood pressure (hypertension) and are often the first medication patients are placed on to manage this condition. Thiazide diuretics target the distal tubule of the kidneys preventing them from reabsorbing sodium back into the body; therefore, the sodium is excreted in the urine.

And wherever sodium goes, potassium is sure to follow!Water is drawn out with the electrolytes into the urine. Thus urine output is increased, and the overall blood volume in the patient is decreased. Also, thiazides are the only diuretics to cause widening of the blood vessels (vasodilation), which is why it is so useful in managing hypertension. Some examples of thiazide diuretics include Chlorothiazide (Diuril), Hydrochlorothiazide (Microzide), and Metolazone (Zaroxolyn).2.

Loop DiureticsThis type of diuretic is most commonly used in managing heart failure, edema, and kidney disease. A loop diuretic acts similarly to a thiazide, prompting sodium, potassium and therefore water to be excreted in the urine. However, some key differences exist. First, it targets the Loop of Henle in the kidney. Secondly, it is an especially potent diuretic, causing a high volume of urine to be excreted.

Some examples of loop diuretics include Furosemide (Lasix) and Torsemide (Demadex).3. Potassium-sparing DiureticsFor some patients, loop and thiazide diuretics are dangerous because they cause the patient to lose not only sodium and water in the urine, but potassium, too. If a patient’s blood potassium is too low (hypokalemia), it can lead to complications, especially if the patient has an underlying heart condition, or kidney or liver dysfunction. Therefore, potassium-sparing diuretics were created. These diuretics cause only sodium and water to be excreted, but keep potassium from following suit.

These medications are used to treat patients with heart failure, liver disease, or kidney disease. Some examples of potassium-sparing diuretics include Spironolactone (Aldactone) and Triamterene (Dyrenium).

Side Effects of Diuretics

Diuretics have a long history in the medical community and are considered a relatively safe class of medications. Understandably, all diuretics when first started cause the patient to urinate more frequently (especially loop diuretics).

However, this side effect usually abates after the patient has been on the medication for several weeks.In addition, diuretics can also cause:

  • Headaches due to dehydration
  • Lightheadedness especially with rapid position changes
  • Extreme thirst

Since diuretics work by affecting electrolyte reabsorption, they can also cause imbalances in these electrolytes, mainly:

  • Low blood sodium (hyponatremia)
  • Low blood potassium (hypokalemia) with thiazide and loop diuretics or conversely high blood potassium (hyperkalemia) with potassium-sparing diuretics

With all the electrolyte changes, patients can experience severe muscle cramping. Lastly, diuretics can worsen some other medical conditions. They have been known to:

  • Increase blood sugar
  • Increase cholesterol
  • Worsen gout symptoms
  • Cause menstrual irregularities

Therefore, if a patient has diabetes, high cholesterol, history of gout, or menstrual abnormalities these types of medications may not be suitable.

Lesson Summary

Diuretics, utilizing the principle of osmosis (in which water naturally flows from an area of lower concentration to higher concentration making the overall solutions equal in concentration), work by causing a patient to release increased amounts of water through the urine.

There are three types of common diuretics:

  1. Thiazide
  2. Loop
  3. Potassium-sparing diuretics

Thiazides are used for high blood pressure, as they decrease the total blood volume and cause widening of blood vessels. Loop diuretics are a potent medication. They cause significant amounts of urine output from a patient, which is useful in treating heart failure and edema (fluid retention). Potassium-sparing diuretics are the only diuretic that prevents potassium from following sodium into the urine output. These are used in managing heart failure, liver, or kidney disease.Common side effects of diuretics are increased urination, headaches, and lightheadedness. In addition, diuretics can cause electrolyte abnormalities (specifically low blood sodium, low blood potassium with loop diuretics, or high blood potassium with potassium-sparing diuretics) and muscle cramping.

Lastly, diuretics can increase blood sugar, increase cholesterol, and prompt gout attacks. Despite these side effects, diuretics are extremely effective tools in managing high blood pressure, heart failure, liver disease, or kidney dysfunction.

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