Diuretics - loop diuretics

Depletions

Osteoporosis (bone loss) is the primary disease associated with long term calcium deficiency; it may be associated with bone pain and spinal deformity. Depleted levels can also cause muscle cramps, irregular heartbeat, and depression.

Magnesium deficiency affects calcium and vitamin D levels in the body and may be associated with muscle cramps, heart irregularities, high blood pressure, diabetes, and osteoporosis (bone loss).

Although phosphorus deficiency is rare, long term low levels are associated with muscle weakness, bone pain, mental confusion, loss of appetite, anemia, increased susceptibility to infection, respiratory difficulties, seizures, and even death.

Symptoms of deficiency include loss of appetite, nausea, drowsiness, feelings of apprehension, excessive thirst, irrational behavior, fatigue, muscle pain and weakness (usually of the lower limbs); severe cases may lead to irregular heartbeat.

Symptoms of depleted levels of thiamine include weakness, fatigue, anorexia, constipation, memory loss, confusion, and depression. Deficiency may lead to beriberi, a condition characterized by inflammation of nerves, heart irregularities, and fluid retention.

Symptoms of vitamin B6 deficiency may include weakness, nervousness, insomnia, mental confusion, irritability, and anemia. Long term low levels of this nutrient may also increase the risk of heart disease, as well as colon and prostate cancers.

Vitamin C deficiency may include bruising, fever, anemia, emotional changes, swollen and bleeding gums, fatigue, lethargy, jaundice (yellowing of the skin and eyes), increased susceptibility to infections, slow wound healing, and swelling of the lower limbs. Severe deficiency leads to scurvy, a disorder that affects muscles and bones and is potentially fatal. However, scurvy is rare these days because of the wide availability of vitamin C from dietary sources.

Editorial Note

The selected depletions information presented here identifies some of the nutrients that may be depleted by certain medications. The signs and symptoms associated with nutrient deficiency may also indicate conditions other than nutrient deficiency. If you are experiencing any of the signs or symptoms mentioned, it does not necessarily mean that you are nutrient deficient. Nutrient depletion depends upon a number of factors, including your medical history, diet, and lifestyle, as well as the length of time you have been taking the medication. Please consult your health care provider; he or she can best assess and address your individual health care needs and determine if you are at risk for nutrient depletions from these medications, as well as others not listed here.

Supporting Research

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Bierwirth J, Ulbricht KU, Schmidt RE, Witte T. Association of common variable immunodeficiency with vitamin B(6) deficiency. Eur J Clin Nutr. 2007; [Epub ahead of print].

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr 1999;69:1086-1087.

Cashman K, Flynn A. Optimal nutrition: calcium, magnesium and phosphorus. Proc Nutr Soc. 1999;58:477-487.

Cashman KD. Diet, nutrition, and bone health. J Nutr. 2007;137(11):2507S-12S.

Chiang EP, Smith DE, Selhub J, Dallal G, Wang YC, Roubenoff R. Inflammation causes tissue-specific depletion of vitamin B6. Arthritis Res Ther. 2005;7(6):R1254-62.

Hordyjewska A, Pasternak K. Magnesium role in cardiovascular diseases. Ann Univ Mariae Curie Sklodowska [Med]. 2004;59(2):108-13.

Humphreys M. Potassium disturbances and associated electrocardiogram changes. Emerg Nurse. 2007;15(5):28-34.

Lee BY, Yanamandra K, Bocchini JA Jr. Thiamin deficiency: a possible major cause of some tumors? (review). Oncol Rep. 2005;14(6):1589-92.

Liamis G, Mitrogianni Z, Liberopoulos EN, Tsimihodimos V, Elisaf M. Electrolyte disturbances in patients with hyponatremia. Intern Med. 2007;46(11):685-90.

Lin SH, Halperin ML. Hypokalemia: a practical approach to diagnosis and its genetic basis. Curr MedChem. 2007;14(14):1551-65.

Nielsen FH, Milne DB, Klevay LM, Gallagher S, Johnson L. Dietary magnesium deficiency induces heart rhythm changes, impairs glucose tolerance, and decreases serum cholesterol in post menopausal women. J Am Coll Nutr. 2007;26(2):121-32.

Ondrak KS, Morgan DW. Physical activity, calcium intake and bone health in children and adolescents. Sports Med. 2007;37(7):587-600.

Pelton R, LaValle J, Hawkins EB, et al. Drug Induced Nutrient Depletion Handbook. Hudson, OH:LexiComp, Inc. 2001:439-441.

Rieck J, Halkin H, Almog S, et al. Urinary loss of thiamine is increased by low doses of furosemide in healthy volunteers. J Lab Clin Med. 1999;134(3):238-243.

Rodríguez-Morán M, Guerrero-Romero F. Serum magnesium and C-reactive protein levels. Arch Dis Child. 2007; [Epub ahead of print].

Sheweita SA, Khoshhal KI. Calcium metabolism and oxidative stress in bone fractures: role of antioxidants. Curr Drug Metab. 2007;8(5):519-25.

Spinneker A, Sola R, Lemmen V, Castillo MJ, Pietrzik K, González-Gross M. Vitamin B6 status, deficiency and its consequences--an overview.Nutr Hosp. 2007;22(1):7-24.

Wooley JA. Characteristics of thiamin and its relevance to the management of heart failure. Nutr Clin Pract. 2008;23(5):487-93.

Alternative Names

Overview

Medications

• Bumetanide
  • Bumex
• Ethacrynic acic
  • Edecrin
• Furosemide
  • Lasix
• Torsemide
  • Demadex