Which medications in the drug class Diuretics, Loop are used in the treatment of Hyperkalemia?

Updated: Jun 20, 2018
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Diuretics, Loop

Loop diuretics markedly enhance renal potassium excretion and thus lower serum levels. Parenterally administered drugs have a more rapid onset of action and are preferable in emergency situations. Simultaneous administration of saline can prevent severe volume depletion.

Furosemide (Lasix)

Furosemide increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium, potassium, and chloride reabsorption in the ascending loop of Henle and distal renal tubule. Furosemide has a slow onset of action (frequently 1 hour), and its effect on lowering the potassium level is inconsistent. Large doses may be needed in renal failure.

Individualize the dose to the patient. For the treatment of edema, depending on the response, administer in increments of 20-40 mg, no sooner than 6-8 hours after the previous dose, until the desired diuresis occurs. When treating infants and children, give 1-2 mg/kg every 6-12 hours. If the diuretic response is not satisfactory, furosemide may be titrated in increments of 1 mg/kg (no sooner than 2 hours after the previous dose) until a satisfactory effect is achieved (up to 6 mg/kg).

Oral absorption of furosemide varies from person to person. If the patient requires rapid and effective therapy, the intravenous (IV) route is preferred. Continuous infusion of furosemide (at rates as high as 40 mg/hr) is occasionally used for severe edema but rarely is required for the treatment of hyperkalemia.

Bumetanide (Bumex)

Bumetanide increases excretion of water by interfering with the chloride-binding cotransport system, which, in turn, inhibits sodium, potassium, and chloride reabsorption in the ascending loop of Henle and distal renal tubule. Individualize the dose to the patient.

For treatment of edema in adults, start at 0.5-1 mg IV or intramuscularly (IM); if the desired response is not achieved, administer a second or third dose at 2-3 hour intervals. Titrate to a maximum dosage of 10 mg/day. Rarely, dosages as high as 20 mg/day are used for edema in patients with renal impairment; however, they generally are not required for treatment of hyperkalemia.

Ethacrynic acid (Edecrin)

Ethacrynic acid increases excretion of water by interfering with the chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. For treatment of edema in adults, start at 0.5-1 mg/kg IV. Typically, 1 dose is all that is needed; occasionally, however, a second dose may be given after 2-4 hours. For second doses, a new injection site should be used so as to avoid possible thrombophlebitis. Single IV doses higher than 100 mg are not recommended.


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