Diuretic-Induced Electrolytic/pH Changes

Drug Effect on serum electrolytes + serum pH

Carbonic • ↓ Na+, ↓ K+ (exchanged for K+ later in collecting ducts)
anhydrase • ↓ HCO3- (can’t absorb from PCT)
inhibitors • ↑ Cl- (absorbed later with Na+; replaces HCO3- as anion)
• Acidosis (↓ HCO3- to buffer, ↑ free H+, ↓ pH)
• Alkaline urine  possible calcium phosphate stones
Loop diuretics • ↓ Na+, ↓ K+ (exchanged for K+ later in collecting ducts)
• ↓ Ca++, ↓ Mg++ (no positive K+ potential)  can’t push
positive electrolytes through junctions
• Alkalosis (↓ H+, ↑ pH)
• Less K+ in serum leads to cellular K+/H+ exchange 
K+ leaves cells, H+ enters cells  ↓ serum H+
• Low plasma K+  Na+ exchanged for H+ instead
Diuretic-Induced Electrolytic/pH Changes
Drug Effect on serum electrolytes + serum pH
Thiazides • ↓ Na+, ↓ K+ (exchanged for K+ later in collecting ducts)
• ↑ Ca++ (less Na+ in DCT cells  stronger Na+ gradient 
easier to absorb Ca++)
• Alkalosis (↓ H+, ↑ pH)
• Less K+ in serum leads to cellular K+/H+ exchange 
K+ leaves cells, H+ enters cells  ↓ serum H+
• Low plasma K+  Na+ exchanged for H+ instead
Potassium • ↓ Na+ (but no exchange)
sparing (ENaC • ↑ K+ (exchanged in collecting duct blocked)
inhibitors +
aldosterone • Acidosis (↓ H +, ↑ pH)

antagonists)