Section of Nephrology and Hypertension, 1st Department of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, St Kiriakidi 1, 54636, Thessaloniki, Greece.
Expert Opin Drug Saf. 2010 Mar;9(2):259-73. doi: 10.1517/14740330903499257.
As with all potent therapeutic agents, the use of diuretic compounds has been linked with several adverse effects that may reduce quality of life and patient compliance and, in some cases, may be associated with considerable morbidity and mortality. Among the various types of adverse effects, disturbances of electrolyte and acid-base balance are perhaps the most common, and some of them are the aetiological factors of other side effects (i.e., hypokalaemia causing ventricular arrhythmias or glucose intolerance). The mechanism and site of action and, therefore, the pharmacological effects of each diuretic class largely determine the specific electrolyte or acid-base abnormalities that will accompany the use of each diuretic agent.
This article reviews the major electrolyte disturbances (hypokalaemia, hyperkalaemia, hyponatraemia, disorders of magnesium and calcium balance), as well as the acid-base abnormalities complicating the use of the various diuretic agents.
The reader will gain insights into the pathogenesis of the diuretic-induced electrolyte and acid-base disorders together with considerations for their prevention and treatment.
Knowledge of the pharmacologic properties of each diuretic class and appropriate monitoring of patients under diuretic treatment represent the most important strategies to prevent the development of diuretic-related adverse events and their consequences.
与所有强效治疗药物一样，利尿剂的使用与多种不良反应相关联，这些不良反应可能会降低生活质量和患者的依从性，在某些情况下，还可能导致相当大的发病率和死亡率。在各种类型的不良反应中，电解质和酸碱平衡紊乱也许是最常见的，其中一些是其他副作用的病因因素（例如，低钾血症引起的室性心律失常或葡萄糖不耐受）。每种利尿剂的作用机制和作用部位，因此，药理学作用在很大程度上决定了每种利尿剂使用时伴随的特定电解质或酸碱异常。
本文综述了主要的电解质紊乱（低钾血症、高钾血症、低钠血症、镁和钙平衡紊乱），以及各种利尿剂使用中并发的酸碱异常。
读者将深入了解利尿剂引起的电解质和酸碱紊乱的发病机制，并考虑到它们的预防和治疗。
了解每种利尿剂的药理学特性，并对接受利尿剂治疗的患者进行适当的监测，是预防利尿剂相关不良事件及其后果的最重要策略。
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