Swanepoel C R
Cardiovasc Drugs Ther. 1994 Feb;8(1):123-8. doi: 10.1007/BF00877100.
The choice of a diuretic depends on knowledge of its efficacy in different disease states as well as the complications associated with its use. However, efficacy of the various diuretic agents as determined in healthy subjects may not always be applicable to the sick patient. The thiazide group appears to be the main offender with regard to hypokalemia and metabolic upsets; these complications seem to stem from long-term use and high dosages. Interest has been expressed on the influence of diuretic induced hypokalemia (and intracellular potassium deficiency) in inducing insulin resistance. The lipid abnormalities may arise as a result of this resistance or may be consequent on hyperinsulinemia from other as yet undetermined mechanisms. In addition, hypertension per se may be associated with insulin resistance. It is interesting to speculate that diuretics, which are commonly used in the treatment of hypertension, may, in some way, perhaps via the induction of hypokalemia, unmask this resistance.
利尿剂的选择取决于对其在不同疾病状态下疗效的了解以及与使用相关的并发症。然而，在健康受试者中确定的各种利尿剂的疗效并不总是适用于患病患者。噻嗪类药物似乎是导致低钾血症和代谢紊乱的主要原因；这些并发症似乎源于长期使用和高剂量。人们已经对利尿剂诱导的低钾血症（以及细胞内钾缺乏）在诱导胰岛素抵抗方面的影响表示关注。脂质异常可能是这种抵抗的结果，也可能是由其他尚未确定的机制导致的高胰岛素血症所致。此外，高血压本身可能与胰岛素抵抗有关。有趣的是，可以推测常用于治疗高血压的利尿剂可能在某种程度上，也许是通过诱导低钾血症，揭示这种抵抗。
