From the Guidelines
Loop diuretics, such as furosemide and torsemide, are the best diuretic options to alkalize the blood.
Diuretic Options
- Loop diuretics: These are the preferred diuretic agents for use in most patients, as they increase sodium excretion up to 20% to 25% of the filtered load of sodium and enhance free water clearance 1.
- Thiazide diuretics: These may be considered in patients with hypertension and mild fluid retention, but they are less effective than loop diuretics in patients with impaired renal function 1.
- Aldosterone antagonists: These, such as spironolactone, may be used in combination with loop diuretics to control ascites in patients with liver cirrhosis, but they are not typically used as first-line agents for alkalizing the blood 1.
Dosage and Administration
- Furosemide: The starting dose is 20–40 mg/day, with a maximum dose of 160 mg/day 1.
- Torsemide: The starting dose is 10 mg/day, with a maximum dose of 100 to 200 mg/day 1.
- Bumetanide: The starting dose is 1.0 mg, with a maximum dose of 4 to 8 mg 1.
Monitoring and Adverse Effects
- Electrolyte depletion: The risk of electrolyte depletion is markedly enhanced when two diuretics are used in combination, and potassium deficits can be corrected by the short-term use of potassium supplements or the addition of magnesium supplements 1.
- Hypokalemia: This is a common adverse effect of loop and thiazide diuretics, and can be managed with potassium supplements or the addition of potassium-sparing agents such as spironolactone or amiloride 1.
- Hyponatremia: This is a common adverse effect of thiazide diuretics, and can be managed by reducing the dose of the diuretic or adding a loop diuretic 1.
From the Research
Diuretic Options
The following diuretic options can be considered to alkalize the blood:
- Thiazide diuretics, such as hydrochlorothiazide, which inhibit sodium reabsorption in the early distal convoluted tubule 2
- Loop diuretics, such as furosemide, which block chloride and sodium reabsorption by inhibition of the Na/K/2Cl cotransport system in the thick ascending limb of the loop of Henle 2, 3
- Potassium-sparing diuretics, including aldosterone receptor blockers (such as spironolactone and eplerenone) and epithelial sodium channel blockers (such as amiloride and triamterene) 2
Mechanism of Action
These diuretics work by:
- Inhibiting sodium transport systems along the length of the renal tubule 4
- Influencing the renal handling of electrolyte-free water, calcium, potassium, protons, sodium bicarbonate, and uric acid 4
- Increasing the excretion of sodium and water, which can help to alkalize the blood 3, 5
Considerations
When using diuretics to alkalize the blood, it is essential to consider the following: