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Diuretic
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<h2 id="medical-uses">Medical uses</h2> <p>In <a href="/facts/Medicine/2fnp90Je">medicine</a>, diuretics are used to treat <a href="/facts/Heart_failure/7fckX3Jm">heart failure</a>, <a href="/facts/Liver_cirrhosis/bkLuLvCD">liver cirrhosis</a>, <a href="/facts/Hypertension/wlAvBfcf">hypertension</a>, <a href="/facts/Influenza/nWuFzh6L">influenza</a>, <a href="/facts/Water_poisoning/Jg0DpnA0">water poisoning</a>, and certain <a href="/facts/Kidney_disease/koq79A75">kidney diseases</a>. Some diuretics, such as <a href="/facts/Acetazolamide/kwTvRugT">acetazolamide</a>, help to make the <a href="/facts/Urine/oNUYVtvX">urine</a> more <a href="/facts/Alkaline/s6NqPGSP">alkaline</a>, and are helpful in increasing <a href="/facts/Excretion/mspsTfnv">excretion</a> of substances such as <a href="/facts/Aspirin/opMK4qLk">aspirin</a> in cases of <a href="/facts/Drug_overdose/Jlo2AX3Y">overdose</a> or poisoning. Diuretics are sometimes abused by athletes who seek to excrete water for quick weight loss and/or to mask their use of banned substances,<a class="footnote-ref" id="fnref:1" href="#fn:1"><sup>1</sup></a> and by people with <a href="/facts/Eating_disorder/3GwQ71sD">eating disorders</a>, especially people with <a href="/facts/Bulimia_nervosa/vha4lPpd">bulimia nervosa</a>, who seek to lose weight. </p><p>The <a href="/facts/Antihypertensive/K63MbxN0">antihypertensive</a> actions of some diuretics (<a href="/facts/Thiazide/y0xU4l4F">thiazides</a> and <a href="/facts/Loop_diuretic/eEgJ4qpf">loop diuretics</a> in particular) are independent of their diuretic effect.<a class="footnote-ref" id="fnref:2" href="#fn:2"><sup>2</sup></a><a class="footnote-ref" id="fnref:3" href="#fn:3"><sup>3</sup></a> That is, the reduction in blood pressure is not due to decreased blood volume resulting from increased <a href="/facts/Urine_production/sKmwSJ8a">urine production</a>, but occurs through other mechanisms and at lower doses than that required to produce <a href="/facts/Diuresis/oWIcAEcN">diuresis</a>. <a href="/facts/Indapamide/SrGjBzp8">Indapamide</a> was specifically designed with this in mind, and has a larger <a href="/facts/Therapeutic/2ytkGbgT">therapeutic</a> window for <a href="/facts/Hypertension/wlAvBfcf">hypertension</a> (without pronounced diuresis) than most other diuretics. </p> <h2 id="types">Types</h2> <h3>High-ceiling/loop diuretics</h3> <p>High-ceiling diuretics may cause a substantial diuresis – up to 20%<a class="footnote-ref" id="fnref:4" href="#fn:4"><sup>4</sup></a> of the filtered load of <a href="/facts/Sodium_chloride/MWcXl3Mb">NaCl</a> (salt) and water. This is large in comparison to normal <a href="/facts/Renal_sodium_reabsorption/4tIAwwEv">renal sodium reabsorption</a> which leaves only about 0.4% of filtered sodium in the urine. <a href="/facts/Loop_diuretics/eEgJ4qpf">Loop diuretics</a> have this ability, and are therefore often synonymous with high-ceiling diuretics. Loop diuretics, such as <a href="/facts/Furosemide/tq9Lx0u4">furosemide</a>, inhibit the body's ability to reabsorb <a href="/facts/Sodium/eYuSPu2V">sodium</a> at the ascending loop in the <a href="/facts/Nephron/ss24U1zW">nephron</a>, which leads to an excretion of water in the urine, whereas water normally follows sodium back into the extracellular fluid. Other examples of high-ceiling loop diuretics include <a href="/facts/Ethacrynic_acid/NCk2QGCn">ethacrynic acid</a> and <a href="/facts/Torasemide/6Bf95x6Q">torasemide</a>. </p> <h3>Thiazides</h3> <p><a href="/facts/Thiazide/y0xU4l4F">Thiazide</a>-type diuretics such as <a href="/facts/Hydrochlorothiazide/2LuDQVCu">hydrochlorothiazide</a> act on the distal convoluted tubule and inhibit the <a href="/facts/Sodium-chloride_symporter/TtuQnmul">sodium-chloride symporter</a> leading to a retention of water in the urine, as water normally follows penetrating solutes. Frequent urination is due to the increased loss of water that has not been retained from the body as a result of a concomitant relationship with sodium loss from the convoluted tubule. The short-term anti-hypertensive action is based on the fact that thiazides decrease preload, decreasing blood pressure. On the other hand, the long-term effect is due to an unknown <a href="/facts/Vasodilator/cjzrU8Ro">vasodilator</a> effect that decreases blood pressure by decreasing resistance.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> </p> <h3>Carbonic anhydrase inhibitors</h3> <p><a href="/facts/Carbonic_anhydrase_inhibitor/NaX2lplt">Carbonic anhydrase inhibitors</a> inhibit the enzyme carbonic anhydrase which is found in the proximal convoluted tubule. This results in several effects including bicarbonate accumulation in the urine and decreased sodium absorption. Drugs in this class include <a href="/facts/Acetazolamide/kwTvRugT">acetazolamide</a> and <a href="/facts/Methazolamide/tYq8qPF6">methazolamide</a>. </p> <h3>Potassium-sparing diuretics</h3> <p>These are diuretics which do not promote the secretion of <a href="/facts/Potassium/5lcumVgo">potassium</a> into the urine; thus, potassium is retained and not lost as much as with other diuretics. The term "potassium-sparing" refers to an effect rather than a mechanism or location; nonetheless, the term almost always refers to two specific classes that have their effect at similar locations: </p> <ul><li><a href="/facts/Aldosterone_antagonist/zbHHR8sT">Aldosterone antagonists</a>: <a href="/facts/Spironolactone/uauzo7MM">spironolactone</a>, which is a <a href="/facts/Competitive_antagonist/PuXHVNdV">competitive antagonist</a> of <a href="/facts/Aldosterone/tjw4dr1u">aldosterone</a>. <a href="/facts/Aldosterone/tjw4dr1u">Aldosterone</a> normally adds sodium channels in the principal cells of the collecting duct and late distal tubule of the nephron. Spironolactone prevents aldosterone from entering the principal cells, preventing sodium reabsorption. Similar agents are <a href="/facts/Eplerenone/xJBzeEvm">eplerenone</a> and <a href="/facts/Potassium_canreonate/R8JXMhRb">potassium canreonate</a>.</li> <li><a href="/facts/Epithelial_sodium_channel_blocker/LFjjbNEx">Epithelial sodium channel blockers</a>: <a href="/facts/Amiloride/JlcLDbvd">amiloride</a> and <a href="/facts/Triamterene/yappgL4p">triamterene</a>.</li></ul> <h3>Calcium-sparing diuretics</h3> <p>The term "calcium-sparing diuretic" is sometimes used to identify agents that result in a relatively low rate of excretion of <a href="/facts/Calcium/hf252CC0">calcium</a>.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> </p><p>The reduced concentration of calcium in the urine can lead to an increased rate of calcium in serum. The sparing effect on calcium can be beneficial in <a href="/facts/Hypocalcemia/HnwyWCL2">hypocalcemia</a>, or unwanted in <a href="/facts/Hypercalcemia/kdEeLaVd">hypercalcemia</a>. </p><p>The <a href="/facts/Thiazide/y0xU4l4F">thiazides</a> and potassium-sparing diuretics are considered to be calcium-sparing diuretics.<a class="footnote-ref" id="fnref:7" href="#fn:7"><sup>7</sup></a> </p> <ul><li>The thiazides cause a net <i>decrease</i> in calcium lost in urine.<a class="footnote-ref" id="fnref:8" href="#fn:8"><sup>8</sup></a></li> <li>The potassium-sparing diuretics cause a net <i>increase</i> in calcium lost in urine, but the increase is <i>much smaller</i> than the increase associated with other diuretic classes.<a class="footnote-ref" id="fnref:9" href="#fn:9"><sup>9</sup></a></li></ul> <p>By contrast, loop diuretics promote a significant increase in calcium excretion.<a class="footnote-ref" id="fnref:10" href="#fn:10"><sup>10</sup></a> This can increase risk of reduced bone density.<a class="footnote-ref" id="fnref:11" href="#fn:11"><sup>11</sup></a> </p> <h3>Osmotic diuretics</h3> <p><a href="/facts/Osmotic_diuretic/WH2TxUtH">Osmotic diuretics</a> (e. g., <a href="/facts/Mannitol/CeHJsKMq">mannitol</a>) are substances that increase osmolarity, but have limited tubular epithelial cell permeability. They work primarily by expanding extracellular fluid and plasma volume, therefore increasing blood flow to the <a href="/facts/Kidney/HBspPrv9">kidney</a>, particularly the peritubular capillaries. This reduces medullary osmolality and thus impairs the concentration of urine in the <a href="/facts/Loop_of_Henle/G4SKYFaH">loop of Henle</a> (which usually uses the high osmotic and solute gradient to transport solutes and water). Further, the limited tubular epithelial cell permeability increases osmolality and thus water retention in the filtrate.<a class="footnote-ref" id="fnref:12" href="#fn:12"><sup>12</sup></a> </p><p>It was previously believed that the primary mechanism of osmotic diuretics such as <a href="/facts/Mannitol/CeHJsKMq">mannitol</a> is that they are filtered in the <a href="/facts/Glomerulus_(kidney)/rlRXJsJy">glomerulus</a>, but cannot be reabsorbed. Thus their presence leads to an increase in the osmolarity of the filtrate and to maintain osmotic balance, water is retained in the urine. </p><p><a href="/facts/Glucose/oUSkoLCD">Glucose</a>, like mannitol, is a sugar that can behave as an osmotic diuretic. Unlike mannitol, glucose is commonly found in the blood. However, in certain conditions, such as <a href="/facts/Diabetes_mellitus/2xeHXbsI">diabetes mellitus</a>, the concentration of glucose in the blood (<a href="/facts/Hyperglycemia/HM8eNqfX">hyperglycemia</a>) exceeds the maximum reabsorption capacity of the kidney. When this happens, glucose remains in the filtrate, leading to the osmotic retention of water in the urine. <a href="/facts/Glucosuria/af605y5o">Glucosuria</a> causes a loss of hypotonic water and Na+, leading to a hypertonic state with signs of volume depletion, such as dry mucosa, hypotension, <a href="/facts/Tachycardia/ycmyzP7q">tachycardia</a>, and decreased turgor of the skin. Use of some <a href="/facts/Drug/FFFUI9n4">drugs</a>, especially <a href="/facts/Stimulant/nmBdAXM5">stimulants</a>, may also increase blood glucose and thus increase urination.. </p> <h3>Low-ceiling diuretics</h3> <p>The term "low-ceiling diuretic" is used to indicate a diuretic has a rapidly flattening <a href="/facts/Dose-response_relationship/DLcuLdHc">dose effect</a> curve (in contrast to "high-ceiling", where the relationship is close to linear). Certain classes of diuretic are in this category, such as the <a href="/facts/Thiazide/y0xU4l4F">thiazides</a>.<a class="footnote-ref" id="fnref:13" href="#fn:13"><sup>13</sup></a> </p> <h2 id="mechanism-of-action">Mechanism of action</h2> <p>Diuretics are tools of considerable therapeutic importance. First, they effectively reduce <a href="/facts/Blood_pressure/VtqqSM2J">blood pressure</a>. Loop and thiazide diuretics are secreted from the proximal tubule via the organic anion transporter-1 and exert their diuretic action by binding to the Na(+)-K(+)-2Cl(-) co-transporter type 2 in the thick ascending limb and the Na(+)-Cl(-) co-transporter in the distal convoluted tubule, respectively.<a class="footnote-ref" id="fnref:14" href="#fn:14"><sup>14</sup></a> </p> <table><tbody><tr><th colspan="4">Classification of common diuretics and their mechanisms of action.</th></tr><tr><th>Class</th><th>Examples</th><th>Mechanism</th><th>Location (numbered in distance along nephron)</th></tr><tr><td><a href="/facts/Ethanol/3lCLfBSP">Ethanol</a></td><td><a href="/facts/Drinking_alcohol/IeK2fVd5">drinking alcohol</a></td><td>Inhibits <a href="/facts/Vasopressin/B1EksWWY">vasopressin</a> secretion</td><td></td></tr><tr><td><a href="/facts/Water/0lkXnJPK">Water</a></td><td></td><td>Inhibits <a href="/facts/Vasopressin/B1EksWWY">vasopressin</a> secretion</td><td></td></tr><tr><td>Acidifying <a href="/facts/Salt_(chemistry)/lsSKwGpn">salts</a></td><td><a href="/facts/Calcium_chloride/e1EwNPGF">calcium chloride</a>, <a href="/facts/Ammonium_chloride/SfXdntlv">ammonium chloride</a></td><td></td><td>1.</td></tr><tr><td><a href="/facts/Arginine_vasopressin_receptor_2/wwYg79Mx">Arginine vasopressinreceptor 2</a> antagonists</td><td><a href="/facts/Amphotericin_B/c2H3NmRQ">amphotericin B</a>, <a href="/facts/Lithium_(medication)/G6Gy0nJU">lithium</a><a class="footnote-ref" id="fnref:15" href="#fn:15"><sup>15</sup></a><a class="footnote-ref" id="fnref:16" href="#fn:16"><sup>16</sup></a></td><td>Inhibits vasopressin's action</td><td>5. <a href="/facts/Collecting_duct/MmpNcpLA">collecting duct</a></td></tr><tr><td><a href="/facts/Vasopressin_receptor_antagonist/hux2vhIM">Selective vasopressin V2 antagonist (sometimes called aquaretics)</a></td><td><a href="/facts/Tolvaptan/nJs5UAQ7">tolvaptan</a>,<a class="footnote-ref" id="fnref:17" href="#fn:17"><sup>17</sup></a> <a href="/facts/Conivaptan/3sUGMJpB">conivaptan</a></td><td>Competitive vasopressin antagonism leads to decreased number of aquaporin channels in the apical membrane of the renal collecting ducts in kidneys, causing decreased water reabsorption. This causes an increase in renal free water excretion (aquaresis), an increase in serum sodium concentration, a decrease in urine osmolality, and an increase in urine output.<a class="footnote-ref" id="fnref:18" href="#fn:18"><sup>18</sup></a></td><td>5. <a href="/facts/Collecting_duct/MmpNcpLA">collecting duct</a></td></tr><tr><td><a href="/facts/Na-H_exchanger/eea96gU6">Na-H exchanger</a> antagonists</td><td><a href="/facts/Dopamine/5gNy8Xkd">dopamine</a><a class="footnote-ref" id="fnref:19" href="#fn:19"><sup>19</sup></a></td><td>Promotes Na+ excretion</td><td>2. <a href="/facts/Proximal_tubule/mkezjse0">proximal tubule</a><a class="footnote-ref" id="fnref:20" href="#fn:20"><sup>20</sup></a></td></tr><tr><td><a href="/facts/Carbonic_anhydrase_inhibitors/NaX2lplt">Carbonic anhydrase inhibitors</a></td><td><a href="/facts/Acetazolamide/kwTvRugT">acetazolamide</a>,<a class="footnote-ref" id="fnref:21" href="#fn:21"><sup>21</sup></a> <a href="/facts/Dorzolamide/hDc05Eqa">dorzolamide</a></td><td>Inhibits H+ secretion, resultant promotion of Na+ and K+ excretion</td><td>2. <a href="/facts/Proximal_tubule/mkezjse0">proximal tubule</a></td></tr><tr><td><a href="/facts/Loop_diuretic/eEgJ4qpf">Loop diuretics</a></td><td><a href="/facts/Bumetanide/FHUVT3XF">bumetanide</a>,<a class="footnote-ref" id="fnref:22" href="#fn:22"><sup>22</sup></a> <a href="/facts/Ethacrynic_acid/NCk2QGCn">ethacrynic acid</a>,<a class="footnote-ref" id="fnref:23" href="#fn:23"><sup>23</sup></a> <a href="/facts/Furosemide/tq9Lx0u4">furosemide</a>,<a class="footnote-ref" id="fnref:24" href="#fn:24"><sup>24</sup></a> <a href="/facts/Torsemide/6Bf95x6Q">torsemide</a></td><td>Inhibits the <a href="/facts/Na-K-2Cl_symporter/a6txwNl7">Na-K-2Cl symporter</a></td><td>3. medullary <a href="/facts/Thick_ascending_limb/cdwcH9vn">thick ascending limb</a></td></tr><tr><td><a href="/facts/Osmotic_diuretic/WH2TxUtH">Osmotic diuretics</a></td><td><a href="/facts/Glucose/oUSkoLCD">glucose</a> (especially in uncontrolled diabetes), <a href="/facts/Mannitol/CeHJsKMq">mannitol</a></td><td>Promotes osmotic diuresis</td><td>2. <a href="/facts/Proximal_tubule/mkezjse0">proximal tubule</a>, <a href="/facts/Descending_limb_of_loop_of_Henle/fhWzywys">descending limb</a></td></tr><tr><td><a href="/facts/Potassium-sparing_diuretic/EE4LqJgw">Potassium-sparing diuretics</a></td><td><a href="/facts/Amiloride/JlcLDbvd">amiloride</a>, <a href="/facts/Spironolactone/uauzo7MM">spironolactone</a>, <a href="/facts/Eplerenone/xJBzeEvm">eplerenone</a>, <a href="/facts/Triamterene/yappgL4p">triamterene</a>, <a href="/facts/Potassium_canrenoate/R8JXMhRb">potassium canrenoate</a>.</td><td>Inhibition of <a href="/facts/Na%252B%2fK%252B-ATPase/SuA4d4Na">Na+/K+ exchanger</a>: Spironolactone inhibits <a href="/facts/Aldosterone/tjw4dr1u">aldosterone</a> action, Amiloride inhibits <a href="/facts/Epithelial_sodium_channel/s7hc7WLd">epithelial sodium channels</a><a class="footnote-ref" id="fnref:25" href="#fn:25"><sup>25</sup></a></td><td>5. <a href="/facts/Cortical_collecting_ducts/MmpNcpLA">cortical collecting ducts</a></td></tr><tr><td><a href="/facts/Thiazide/y0xU4l4F">Thiazides</a></td><td><a href="/facts/Bendroflumethiazide/pjBHStP9">bendroflumethiazide</a>, <a href="/facts/Hydrochlorothiazide/2LuDQVCu">hydrochlorothiazide</a></td><td>Inhibits reabsorption by <a href="/facts/Sodium-chloride_symporter/TtuQnmul">Na+/Cl− symporter</a></td><td>4. <a href="/facts/Distal_convoluted_tubules/XztAuM4G">distal convoluted tubules</a></td></tr><tr><td><a href="/facts/Xanthine/3ARA2QCg">Xanthines</a></td><td><a href="/facts/Caffeine/Hx6E2QC5">caffeine</a>, <a href="/facts/Theophylline/qJzjQVB2">theophylline</a>, <a href="/facts/Theobromine/1L7mWzQ4">theobromine</a></td><td>Inhibits reabsorption of Na+, increase <a href="/facts/Glomerular_filtration_rate/kJKJge0o">glomerular filtration rate</a></td><td>1. tubules</td></tr></tbody></table> <p>Caffeine when initially consumed in large quantities is both a diuretic and a <a href="/facts/Natriuresis/FbQy3VXJ">natriuretic</a>,<a class="footnote-ref" id="fnref:26" href="#fn:26"><sup>26</sup></a> but this effect disappears with chronic consumption.<a class="footnote-ref" id="fnref:27" href="#fn:27"><sup>27</sup></a><a class="footnote-ref" id="fnref:28" href="#fn:28"><sup>28</sup></a><a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a> </p> <h2 id="adverse-effects">Adverse effects</h2> <p>The main adverse effects of diuretics are <a href="/facts/Hypovolemia/MmP8TsPw">hypovolemia</a>, <a href="/facts/Hypokalemia/XvS1S7s6">hypokalemia</a>, <a href="/facts/Hyperkalemia/epfvUg5w">hyperkalemia</a>, <a href="/facts/Hyponatremia/Mgj855r3">hyponatremia</a>, <a href="/facts/Metabolic_alkalosis/M4KlT5b7">metabolic alkalosis</a>, <a href="/facts/Metabolic_acidosis/sSKCKBHA">metabolic acidosis</a>, and <a href="/facts/Hyperuricemia/D2R1Sk0M">hyperuricemia</a>.<a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> </p> <table><tbody><tr><th><a href="/facts/Adverse_effect/vAhfbr1J">Adverse effect</a></th><th>Diuretics</th><th>Symptoms</th></tr><tr><td><a href="/facts/Hypovolemia/MmP8TsPw">hypovolemia</a></td><td><ul><li><a href="/facts/Loop_diuretic/eEgJ4qpf">loop diuretics</a><a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a></li><li><a href="/facts/Thiazide/y0xU4l4F">thiazides</a><a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a></li></ul></td><td><ul><li><a href="/facts/Lassitude/C2oo4Hvg">lassitude</a><a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a></li><li><a href="/facts/Thirst/bVLNkyqR">thirst</a><a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a></li><li><a href="/facts/Muscle_cramps/h42IKvK6">muscle cramps</a><a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a></li><li><a href="/facts/Hypotension/BhrdVVRS">hypotension</a><a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a></li></ul></td></tr><tr><td><a href="/facts/Hypokalemia/XvS1S7s6">hypokalemia</a></td><td><ul><li><a href="/facts/Acetazolamide/kwTvRugT">acetazolamides</a><a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a></li><li><a href="/facts/Loop_diuretic/eEgJ4qpf">loop diuretics</a><a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a></li><li><a href="/facts/Thiazide/y0xU4l4F">thiazides</a><a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a></li></ul></td><td><ul><li><a href="/facts/Muscle_weakness/4atjuBIl">muscle weakness</a><a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a></li><li><a href="/facts/Paralysis/Sh1Rqr8R">paralysis</a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a></li><li><a href="/facts/Heart_arrhythmia/ooEpr46Q">arrhythmia</a><a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a></li></ul></td></tr><tr><td><a href="/facts/Hyperkalemia/epfvUg5w">hyperkalemia</a></td><td><ul><li><a href="/facts/Amiloride/JlcLDbvd">amilorides</a><a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a></li><li><a href="/facts/Triamterene/yappgL4p">triamterenes</a><a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a></li><li><a href="/facts/Spironolactone/uauzo7MM">spironolactone</a><a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a></li></ul></td><td><ul><li><a href="/facts/Heart_arrhythmia/ooEpr46Q">arrhythmia</a><a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a></li><li><a href="/facts/Muscle_cramp/h42IKvK6">muscle cramps</a><a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a></li><li><a href="/facts/Paralysis/Sh1Rqr8R">paralysis</a><a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a></li></ul></td></tr><tr><td><a href="/facts/Hyponatremia/Mgj855r3">hyponatremia</a></td><td><ul><li><a href="/facts/Thiazide/y0xU4l4F">thiazides</a><a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a></li><li><a href="/facts/Furosemide/tq9Lx0u4">furosemides</a><a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a></li></ul></td><td><ul><li><a href="/facts/Central_nervous_system/k8I6To97">CNS symptoms</a><a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a><ul><li><a href="/facts/Coma/N9oQ7g7R">coma</a><a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a></li></ul></li></ul></td></tr><tr><td><a href="/facts/Metabolic_alkalosis/M4KlT5b7">metabolic alkalosis</a></td><td><ul><li><a href="/facts/Loop_diuretic/eEgJ4qpf">loop diuretics</a><a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a></li><li><a href="/facts/Thiazide/y0xU4l4F">thiazides</a><a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a></li></ul></td><td><ul><li><a href="/facts/Heart_arrhythmia/ooEpr46Q">arrhythmia</a><a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a></li><li><a href="/facts/Central_nervous_system/k8I6To97">CNS symptoms</a><a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a></li></ul></td></tr><tr><td><a href="/facts/Metabolic_acidosis/sSKCKBHA">metabolic acidosis</a></td><td><ul><li><a href="/facts/Acetazolamide/kwTvRugT">acetazolamides</a><a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a></li><li><a href="/facts/Amiloride/JlcLDbvd">amilorides</a><a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a></li><li><a href="/facts/Triamterene/yappgL4p">triamterene</a><a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a></li></ul></td><td><ul><li><a href="/facts/Kussmaul_respirations/rSs9R8l3">Kussmaul respirations</a><a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a></li><li><a href="/facts/Muscle_weakness/4atjuBIl">muscle weakness</a></li><li><a href="/facts/Neurological_symptoms/eQKKs7jX">neurological symptoms</a><a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a><ul><li><a href="/facts/Lethargy/wJFlYuB7">lethargy</a></li><li><a href="/facts/Coma/N9oQ7g7R">coma</a></li><li><a href="/facts/Seizures/zuIrQyze">seizures</a></li><li><a href="/facts/Stupor/09yVbEKE">stupor</a></li></ul></li></ul></td></tr><tr><td><a href="/facts/Hypercalcemia/kdEeLaVd">hypercalcemia</a></td><td><ul><li><a href="/facts/Thiazide/y0xU4l4F">thiazides</a><a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a></li></ul></td><td><ul><li><a href="/facts/Gout/ktWD69YP">gout</a></li><li>tissue <a href="/facts/Calcification/NRSv3tMS">calcification</a><a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a></li><li><a href="/facts/Fatigue_(medical)/C2oo4Hvg">fatigue</a></li><li><a href="/facts/Depression_(mood)/GDNFWm1L">depression</a></li><li><a href="/facts/Confusion/Pcvw6deb">confusion</a></li><li><a href="/facts/Anorexia_(symptom)/G7RsaXp9">anorexia</a></li><li><a href="/facts/Nausea/dyhkcbeD">nausea</a></li><li><a href="/facts/Vomiting/R2vQkHqV">vomiting</a></li><li><a href="/facts/Constipation/l4DHHM6L">constipation</a></li><li><a href="/facts/Pancreatitis/gmbNTcCG">pancreatitis</a></li><li><a href="/facts/Increased_urination/KIJNqUu9">increased urination</a></li></ul></td></tr><tr><td><a href="/facts/Hyperuricemia/D2R1Sk0M">hyperuricemia</a></td><td><ul><li><a href="/facts/Loop_diuretic/eEgJ4qpf">loop diuretics</a><a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a></li><li><a href="/facts/Thiazide/y0xU4l4F">thiazides</a><a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a></li></ul></td><td><ul><li><a href="/facts/Gout/ktWD69YP">gout</a><a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a></li></ul></td></tr></tbody></table> <h2 id="abuse-in-sports">Abuse in sports</h2> <p>A common application of diuretics is for the purposes of invalidating <a href="/facts/Drug_test/lThw7FSl">drug tests</a>.<a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a> Diuretics increase the urine volume and dilute <a href="/facts/Doping_in_sport/h776s7YA">doping</a> agents and their metabolites. Another use is to rapidly lose weight to meet a <a href="/facts/Weigh-in/xvHv0qH6">weight category</a> in sports like <a href="/facts/Boxing/BrY1zmP4">boxing</a> and <a href="/facts/Wrestling/mTFzecQw">wrestling</a>.<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a><a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Antidiuretic/DxTpGRqB">Antidiuretic</a></li> <li><a href="/facts/Laxative/Sd8bddoF">Laxative</a></li> <li><a href="/facts/Diuresis/oWIcAEcN">Diuresis</a></li> <li><a href="/facts/Drinking/0z0lG5FW">Hydration</a></li> <li><a href="/facts/Water_poisoning/Jg0DpnA0">Water poisoning</a></li> <li><a href="/facts/Dehydration/2RXJ8GGI">Dehydration</a></li></ul> <h2 id="external-links">External links</h2> <ul><li><a href="http://cvpharmacology.com/diuretic/diuretics.htm">Diagram at cvpharmacology.com</a></li> <li><a href="http://www.livestrong.com/article/524634-caffeine-and-electrolyte-imbalance/">"Caffeine and Electrolyte Imbalance"</a> by Dana George August 23, 2011</li></ul> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Cadwallader, Amy; de la Torre, Xavier; Tieri, Alessandra; Botrè, Francesco (September 2010). 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ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:36" class="footnote-back-ref">↩</a></p></li> <li id="fn:37"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:37" class="footnote-back-ref">↩</a></p></li> <li id="fn:38"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:38" class="footnote-back-ref">↩</a></p></li> <li id="fn:39"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:39" class="footnote-back-ref">↩</a></p></li> <li id="fn:40"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:40" class="footnote-back-ref">↩</a></p></li> <li id="fn:41"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:41" class="footnote-back-ref">↩</a></p></li> <li id="fn:42"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:42" class="footnote-back-ref">↩</a></p></li> <li id="fn:43"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:43" class="footnote-back-ref">↩</a></p></li> <li id="fn:44"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:44" class="footnote-back-ref">↩</a></p></li> <li id="fn:45"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:45" class="footnote-back-ref">↩</a></p></li> <li id="fn:46"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:46" class="footnote-back-ref">↩</a></p></li> <li id="fn:47"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:47" class="footnote-back-ref">↩</a></p></li> <li id="fn:48"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:48" class="footnote-back-ref">↩</a></p></li> <li id="fn:49"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:49" class="footnote-back-ref">↩</a></p></li> <li id="fn:50"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:50" class="footnote-back-ref">↩</a></p></li> <li id="fn:51"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:51" class="footnote-back-ref">↩</a></p></li> <li id="fn:52"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:52" class="footnote-back-ref">↩</a></p></li> <li id="fn:53"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:53" class="footnote-back-ref">↩</a></p></li> <li id="fn:54"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:54" class="footnote-back-ref">↩</a></p></li> <li id="fn:55"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:55" class="footnote-back-ref">↩</a></p></li> <li id="fn:56"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:56" class="footnote-back-ref">↩</a></p></li> <li id="fn:57"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:57" class="footnote-back-ref">↩</a></p></li> <li id="fn:58"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:58" class="footnote-back-ref">↩</a></p></li> <li id="fn:59"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:59" class="footnote-back-ref">↩</a></p></li> <li id="fn:60"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:60" class="footnote-back-ref">↩</a></p></li> <li id="fn:61"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:61" class="footnote-back-ref">↩</a></p></li> <li id="fn:62"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:62" class="footnote-back-ref">↩</a></p></li> <li id="fn:63"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:63" class="footnote-back-ref">↩</a></p></li> <li id="fn:64"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:64" class="footnote-back-ref">↩</a></p></li> <li id="fn:65"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. ISBN 978-1-4160-2328-9. <a href="978-1-4160-2328-9" target="_blank">978-1-4160-2328-9</a> <a href="#fnref:65" class="footnote-back-ref">↩</a></p></li> <li id="fn:66"><p>Boron, Walter F. (2004). Medical Physiology: A Cellular And Molecular Approach. Elsevier/Saunders. p. 875. 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