Diuretics: Physiological effects

Last modified: Sunday, 31. May 2009 - 1:54 pm

Diuretics increase urine and sodium output, and in some cases they may also increase urinary output of potassium, calcium, and magnesium. In large quantities, they can affect electrolyte balance.
Harmful side effects
The main risk of diuretic abuse is severe dehydration. This is of special concern to athletes who might take the drug to make weight for sporting events or to improve performance. Anyone exercising or participating in athletic competition is already at risk for dehydration from the fluids they are losing from sweating; diuretics can accelerate the process.
Anyone who must take diuretics for therapeutic purposes should take the proper precautions when exercising. This includes adequate and regular intake of water, sports drinks, or other non-caffeinated fluids; loose and comfortable clothing; adequate rest periods; and awareness of the signs of heat exhaustion (clammy and cool skin, fatigue, nausea, weakness, confusion, vision disturbances, and a possible loss of consciousness).
Other common side effects of diuretic use may include:
• rash
• dizziness
• urinary incontinence
• photosensitivity (a sensitivity to sunlight)
• high blood glucose levels (blood sugars)
Other side effects that have been reported with diuretic use, but are not considered common, include:
• hearing loss
• pancreatitis
• anemia
• leukopenia (depletion of white blood cells)
Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene) may cause a dangerous build-up of excessive potassium in the body. Signs of hyperkalemia, or excess potassium, include:
• arrhythmia (irregular heartbeat)
• breathing difficulties
• numbness or tingling sensation in the hands or feet
• fatigue
• weakness
• anxiety and/or difficulty concentrating
The potassium-depleting diuretics (e.g., hydrochlorothiazide, chlorthalidone, metolazone) cause potassium loss that may be reversed by supplementation and/or dietary adjustments. As previously stated, potassium can be harmful in high amounts, so any supplementation should be recommended and supervised by a doctor.
• fast or irregular heartbeat
• muscle cramps
• nausea and/or vomiting
• dry mouth and persistent thirst
• fatigue
• weakness
• mood swings
Although diuretics may sometimes be given to pregnant women suffering from preeclampsia, in general, diuretic use is usually not recommended in pregnancy because of the potential risk to the developing fetus. In addition, some diuretics may pass through into breast milk and can cause lactation problems. Therefore, women who are pregnant or breastfeeding should always check with their doctor before taking diuretics.
Certain types of diuretics may be contraindicated (not recommended) for use by people with chronic medical conditions, including diabetes, pancreatitis, and lupus erythematosus. Anyone with a known allergy to diuretics or to sulfa drugs should alert their doctor before taking a diuretic.
Long-term health effects
Anyone taking diuretics for longer than six months may experience a folate, or folic acid, deficiency. Folic acid plays a part in the health and reproduction of virtually every cell in the body. It is responsible for protein metabolism, the prevention of neural tube defects in pregnancy, blood cell production, and the synthesis of neurotransmitters. Individuals with folate deficiencies may suffer from anemia, depression and other mood disorders, and may give birth to babies with neural tube defects. Supplementation with folic acid may be useful in reversing these effects.
Individuals on long-term diuretic therapy may also experience elevated levels of homocysteine, an amino acid regulated by folate. High homocysteine levels increase the risk of heart disease. Thiamin, or vitamin B1, depletion is another possible side effect of loop diuretics. Individuals with thiamin deficiencies are at risk for fatigue, heart enlargement, muscle cramps, heart rate irregularities, and impaired mental function.
Insufficient zinc intake is another possible side effect of diuretic use. Individuals with zinc deficiency may experience hair loss, problems with night vision, slow wound healing, dermatitis, and a predisposition to infection and illness due to lowered immune function.
Because diuretics affect electrolyte balance, they can cause deficiencies in magnesium and calcium as well as the previously mentioned potassium. Magnesium deficiency may occur with chronic use of the loop and thiazide diuretics. Symptoms include nausea and vomiting, muscle cramps and weakness, insomnia, arrhythmia (irregular heartbeat), difficulty sleeping, and a loss of exercise tolerance. Calcium deficiency is a possible side effect of both loop and potassium-sparing diuretics. Signs of insufficient calcium in the body include muscle cramps, low bone density (which may be indicated by bones that break easily), tooth decay, heart palpitations, and difficulty sleeping.

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