Baglin A, Boulard J C, Hanslik T, Prinseau J
Service de Médecine Interne et de Néphrologie, Université René Descartes-Paris V, France.
Drug Saf. 1995 Mar;12(3):161-7. doi: 10.2165/00002018-199512030-00002.
There is a wide variety of diuretic-induced metabolic abnormalities of unequal severity. Renal failure can be caused by excessive sodium loss, or by certain drug combinations comprising, for instance, a nonsteroidal anti-inflammatory drug (NSAID) or an ACE inhibitor. Hyponatraemia is uncommon. It is encountered with thiazides, especially among women. A sodium level less than 120 mmol/L may result in neurological complications. Hypokalaemia is frequent and might increase the risk of cardiac arrhythmia. Hyperkalaemia induced by potassium-sparing diuretics is often combined with another contributive cause. Glucidic, lipidic and uric acid abnormalities are common, but their clinical effects are slight. They do not seem to worsen cardiovascular risks among elderly patients. Nevertheless, prescribing diuretics for elderly patients requires special precautions. Reducing the diuretic dose, as is now recommended for treating hypertension, seems to lessen adverse effects, and despite all the adverse reactions just mentioned, it has been proven that diuretics are beneficial in many diseases.
利尿剂可引发多种严重程度不等的代谢异常。肾衰竭可能由钠过度流失或某些药物组合引起，例如非甾体抗炎药（NSAID）或血管紧张素转换酶抑制剂（ACE抑制剂）。低钠血症并不常见，噻嗪类利尿剂可导致低钠血症，尤其在女性中更为常见。血钠水平低于120 mmol/L可能会引发神经并发症。低钾血症较为常见，可能会增加心律失常的风险。保钾利尿剂引起的高钾血症常伴有其他促成因素。糖、脂和尿酸异常较为常见，但其临床影响较小。它们似乎不会增加老年患者的心血管风险。然而，为老年患者开具利尿剂需要特别谨慎。按照目前治疗高血压的建议减少利尿剂剂量，似乎可以减轻不良反应，尽管存在上述所有不良反应，但已证实利尿剂对许多疾病有益。
