Indicate the indication before the ingestion of osmotic diuretics. Clinical pharmacology of diuretics

Osmotic diuretics - ce Mannitol, or Mannitol, Sorbit, Sechovin, or Carbamide, Potassium acetate, as well as concentrated glucose and glycerol. The stench is the most powerful sechoginnimi.

Pharmacodynamics and pharmacokinetics

The preparations of diuretic groups are used to promote the movement of osmotic pressure in a rare part of the blood, through which the blood is released from tissues, in which accumulations are produced until swelling appears. As a result, there is an increase in blood circulation in the glomerular zone due to the expansion of arterioles, which bring, and the growth of hydrostatic pressure in the capillary region. The purpose of the zoom is to increase the filtration rate of buildings - this is the main mechanism of di osmodiuretics. Їх recognition of spriyaє also zbіlshennya obyagu krovі and decrease oncotic vice in the glomeruli. At the same time, a decrease in the processes of soaking sodium and chlorine is observed.

In nephron, osmotic uretics are badly wetted into the bloodstream, through which the osmotic pressure of the cut, which settles in the tubules, increases. Tse to cause damage to the concentration function of the nephron and the intake of water and sodium before the appearance. Zavdyaki such a mechanism for the growth of vision.

As a result, an increase in the volume of blood in the vessels is indicated by specific clitin, rotting in the right atrium and liver, natriuretic factor. This presence disrupts the absorption of sodium ions in the proximal tubules of the nirok and changes the production of aldosterone, which causes a shift in sodium reabsorption and distal tubules to the nephron.

The most popular among the preparations in the group may be Mannitol, so others may have less trival and less pronounced therapeutic effect. It should be noted that the sechoina with protection is prescribed in case of damage to the functioning of the liver.

Osmotic diuretics may have the following effects:

• increased diuresis;
• pіdyom pokaznikіv arterial vice (zooming by growing blood volume in the vessels).

Preparations from a group of diuretics are introduced into the body internally struminely for the treatment of symptoms of acute illnesses and at the same time not dropwise. Manit is practically not to pass at soft fabrics to that after the introduction to be in the ships. Why can't you say about Uchevin and Sorbite, as they are made of shvidko rozpodіlyayutsya on clitin fabrics. After the introduction of the sechovin, it will be transformed into metabolites, through the osmotic pressure it will grow in the cells, and not in the vessels; Such a phenomenon was called the “ricochet effect”. Sorbitol after consumption in cells, yak and sechovin, is easily metabolized by glycogen; through this, the effectiveness of the drug is significantly reduced.

The mechanism of transformation Manita in children up to several months is more common in older children, through the sechogenous action it is possible to save it by stretching more than a three-year hour.

Pobichna diya

With the introduction of osmotic diuretics, side effects of drugs can be:

• headache;
• feel like a nudoti;
• vomiting;
• sickness and bloodshed, which lead to death of fabrics (indicated at times of sub-prime introduction);
• symptoms of bilirubinic encephalopathy and hemophilia, which are due to increased penetration of the blood-brain barrier for drugs and bilirubin;
• the effect of rebound and the increase in excess nitrogen during the treatment of the sechonovy.

Indications and contraindications

Osmotic diuretics are prescribed:

• for early molding, or to use a swollen brain in case of a shock state and newborns;
• for lowering obsyagu and virazhennosti nabryaku brain before the cob of operational vtruchannya;
• for early reduction of glomerular filtration rate after operative insertion through a mechanical zhovtyanitsa;
• it is true that they are recognized at the time that wine through a toxic injection on the distal route to gasoline, gas, turpentine and formalin;
• to improve diuresis at the optimal level during surgery on vessels and hearts with open access;
• in case of glaucoma in the period of the crisis, at the hour of the preoperative preparation and in the postoperative period;
• for the use of poisons with drugs (barbiturates, salicylates, sulfonamides, PAS, boric acid); blasting speeches, which provoke the destruction of erythrocytes (octoic or oxalic acids, farbs, antifreezes, retailers);
• at different transfusions of an insane blood group.

Appointment of osmotic diuretics, zokrem, Mannitol spriya tinnitus sechі for rahunka disintegration of the greater part of toxic speeches, which can be seen to weak acids, that decrease in salivary smoky nirkah. And it will also help the establishment of the siege of hemoglobin, the manifestation of some kind of provokes the closure of the lumen of the nirkovic tubules and the development of anuria. In the case of progressive concussions through an overdose of non-steroidal anti-inflammatory drugs, Mannitol is indicated to help relieve the symptoms that may occur from the cut.

• As an addition to the main treatment in case of shock, opia, septic injury, peritonitis and osteomyelitis. In case of these diseases, such diuretics reduce the elimination of toxins from the body and increase the arterial pressure.
• To increase diuresis, there are signs of acute tubular necrosis.
• In the treatment of hypoosmolar dialysis syndrome. Through the rapid introduction of the speech, which is added to the osmolarity from the postacute rіdina during hemodialysis and peritoneal dialysis, the osmolarity of the rієї rіdini decreases. Through it, the homeland directs itself into the cells themselves, provoking their swell, which is negatively signified in the first line on the brain and pushes the arterial pressure. Through it, symptoms appear: headache, tedium, spasm of the muscles in case of malignant pains, restlessness, drowsiness and convulsions. The use of osmotic diuretics normalizes the osmolarity of the blood, which leads to a change in the pressure on the brain and eyes.
• Varto give respect to those who are allowed to recognize them in case of prerenal hospital deficiency.

Contraindication to recognition:

• Vipadki razvitku nakryaku after head injury followed by the development of the ignition process in the brain or shells. In such cases, the indication of osmotic uretics is contraindicated through damage to the blood-brain barrier (there is no difference in indications of osmotic pressure in vessels and liquor). It is not recommended to recognize them as newborns in case of brain swelling due to the lack of histohematic barriers.
• When there is a contraction of the legenev tissue through heart failure, the increase in the volume of circulating blood causes an increase in the pressure on the heart.
• Although these are signs of toxic damage to the heart, they cannot be administered.
• As a major insufficiency has passed into the oliguric phase, then the sechogenous preparations, which are administered, are no longer excreted from the body, but are trapped in the bloodstream. This is the reason for the increase in the symptoms of inflammation, for which the greater world suffers the head brain. Patients show symptoms of suffocation of the functioning of the brain, uncharacteristic for the degree of severity of apparent uremia: drowsiness, drowsiness, coma and a decrease in the level of sodium in the blood.

With the introduction of drugs, such side effects can develop, such as impaired functioning of the mucosal-intestinal tract, allergies, thrombosis and inflamed veins.

This group of diuretics is used to relieve the symptoms of states that develop rapidly. The world of stabilization has a sickly stink. With the use of osmotic diuretics, Mannitol is more likely to stagnate, which may lead to sechoginous diuretics and a low risk of symptoms. side activities drug after administration

Sechoginnimi drugs (diuretics) name medicinal products (LZ) that interact with different nephrons of the nephron of the nirk, after which there is a greater increase in the section (diuretic effect) and salts (saluretic effect).

Physiology of secho-creation and vision

Nirka can be folded and is composed of numerical (about 1 million) structural and functional units - nephrons.

At the heart of the siecho-creation and siecho-formation lie the following physiological processes:

Glomerular filtration - the process of the elimination of the primary blood flow (up to 150-170 l / doba) as a result of blood filtration through the Bowman-Shumlyansky capsule in the glomeruli.

Tubular reabsorption - the process of reconciliation of the secondary section (1.5-1.7 l / doba).

Tubal secretion - the process of active detection of potassium ions from the blood in the section (at the lumen of the tubule) on the level of the distal nephron.

The skin of the nephron avenges the glomerulus of the vessels, which is tied to the tubular apparatus at the Bowman-Shumlyansky capsule. Through the walls of the capillaries of the vessel glomerulus, plasma filtration of large molecular proteins enters the capsule. The process of filtration is even more intensive: with a stretch, 150-170 liters of filtrate - the primary section - are settled. The filtrate is found near the tubules, it is supposed to be significant, by 99%, to the blood wetting, tobto. reabsorption. In this way, after reabsorption in the tubules, less than 1% of water is lost, which should be 1.5-1.7 liters for the production (normal dobovy diuresis). In this case, the reabsorption of water in the tubules is closely related to the reabsorption of various ions of sodium, potassium, chlorine and other.

Tubular reabsorption is a complex process in which various enzymes (carboangidrase) and hormones (aldosterone, antidiuretic hormone) take part.

Classification of seed production

There is no single classification of sechoginal benefits.

Diuretics can be classified as follows:

Localization of disease in the hallus of the nephron:

proximal tubule: carbonangidraz inhibitors ( diacarb), osmodiuretics ( beckons);

vishіdny viddіl loops of Henle - loop diuretics ( furosemide, uregit);

kіntseva (cortical) vein of the viscous ventral loop of Henle and pochatkov va of the distal tubule: thiazide diuretics ( dichlotiazide) and thiazide-like diuretics ( indapamide, clopamide);

terminal part of distal tubules and selected tubules: antagonism to aldosterone ( spironolactone, triamterene, amiloride).

For an injection for the exchange of potassium ions:

remove potassium from the body in the cross section: furosemide, uregitis, dichlotiazide and in;

potassium-sparing diuretics (spironolactone, triamtiren, amiloride).

For a splash on the acid puddle rivnovaga:

diuretics that evoke metabolic acidosis: diacarb;

diuretics that can be used in case of chronically reduced metabolic acidosis: amiloride, spironolactone, triamterene;

diuretics that can be used in case of chronic death of metabolic alkalosis: furosemide, uregit, bufenox, dichlotiazide.

Behind the mechanism dії:

diuretics that directly affect the function of the nirk tubules: furosemide, dichlotiazide and in;

diuretics that increase the osmotic pressure: osmodiuretin (manit);

aldosterone antagonists: direct (spironolactone), indirect (triamtirene, amiloride).

As a sechogeny, make the most widely vicorous preparations, which will ignite the impact on the function of the epithelium of the nirk tubules, tobto. inhibit sodium and water reabsorption (furosemide, dichlotiazide and in).

For practical activities, I am of interest classification of sechoginic effects due to the strength and flexibility of the development of the diuretic effect.

Potuzhnі chi strong diuretics. Sechoginnі ekstrenoї dії.

Sechoginnі average strength and swidkostі diї.

Sechoginnі drugs and povіlnoї and weak diuretic diї.

Sechoginnimi drugs (diuretics) name medicinal products (LZ) that interact with different nephrons of the nephron of the nirk, after which there is a greater increase in the section (diuretic effect) and salts (saluretic effect).

Physiology of secho-creation and vision

Nirka can be folded and is composed of numerical (about 1 million) structural and functional units - nephrons.

At the heart of the siecho-creation and siecho-formation lie the following physiological processes:

Glomerular filtration - the process of the elimination of the primary blood flow (up to 150-170 l / doba) as a result of blood filtration through the Bowman-Shumlyansky capsule in the glomeruli.

Tubular reabsorption - the process of reconciliation of the secondary section (1.5-1.7 l / doba).

Tubal secretion - the process of active detection of potassium ions from the blood in the section (at the lumen of the tubule) on the level of the distal nephron.

The skin of the nephron avenges the glomerulus of the vessels, which is tied to the tubular apparatus at the Bowman-Shumlyansky capsule. Through the walls of the capillaries of the vessel glomerulus, plasma filtration of large molecular proteins enters the capsule. The process of filtration is even more intensive: with a stretch, 150-170 liters of filtrate - the primary section - are settled. The filtrate is found near the tubules, it is supposed to be significant, by 99%, to the blood wetting, tobto. reabsorption. In this way, after reabsorption in the tubules, less than 1% of water is lost, which should be 1.5-1.7 liters for the production (normal dobovy diuresis). In this case, the reabsorption of water in the tubules is closely related to the reabsorption of various ions of sodium, potassium, chlorine and other.

Tubular reabsorption is a complex process in which various enzymes (carboangidrase) and hormones (aldosterone, antidiuretic hormone) take part.

Classification of seed production

There is no single classification of sechoginal benefits.

Diuretics can be classified as follows:

Localization of disease in the hallus of the nephron:

proximal tubule: carbonangidraz inhibitors ( diacarb), osmodiuretics ( beckons);

vishіdny viddіl loops of Henle - loop diuretics ( furosemide, uregit);

kіntseva (cortical) vein of the viscous ventral loop of Henle and pochatkov va of the distal tubule: thiazide diuretics ( dichlotiazide) and thiazide-like diuretics ( indapamide, clopamide);

terminal part of distal tubules and selected tubules: antagonism to aldosterone ( spironolactone, triamterene, amiloride).

For an injection for the exchange of potassium ions:

remove potassium from the body in the cross section: furosemide, uregitis, dichlotiazide and in;

potassium-sparing diuretics (spironolactone, triamtiren, amiloride).

For a splash on the acid puddle rivnovaga:

diuretics that evoke metabolic acidosis: diacarb;

diuretics that can be used in case of chronically reduced metabolic acidosis: amiloride, spironolactone, triamterene;

diuretics that can be used in case of chronic death of metabolic alkalosis: furosemide, uregit, bufenox, dichlotiazide.

Behind the mechanism dії:

diuretics that directly affect the function of the nirk tubules: furosemide, dichlotiazide and in;

diuretics that increase the osmotic pressure: osmodiuretin (manit);

aldosterone antagonists: direct (spironolactone), indirect (triamtirene, amiloride).

As a sechogeny, make the most widely vicorous preparations, which will ignite the impact on the function of the epithelium of the nirk tubules, tobto. inhibit sodium and water reabsorption (furosemide, dichlotiazide and in).

For practical activities, I am of interest classification of sechoginic effects due to the strength and flexibility of the development of the diuretic effect.

Potuzhnі chi strong diuretics. Sechoginnі ekstrenoї dії.

Sechoginnі average strength and swidkostі diї.

Sechoginnі drugs and povіlnoї and weak diuretic diї.

Which is most often victorious for exaltation of arterial hypertension and insufficiency (calling, for example, heart, liver or nirk insufficiency). Tsya group of sechoginnyh zasobiv is homogeneous pharmacological research, And the speeches are shaken one by one, only by trivality and the power of diy.

This particular class of sechoginal benefits was developed as early as 1950s. The first drug given to the group of buv. It should be noted that the most thiazide diuretics in the world are the most available drugs for the treatment of arterial hypertension.

The world's first thiazide diuretic is chlorthiazide.

Thiazide diuretics can be seen from two sides: from one side, there is a particular type of molecules with a simple structure, from the other side, the whole with a simple mechanism of action. I can be a plutanin, so that some molecules look like thiazide diuretics, although they don’t stink from a chemical point of view. In this context, "thiazide" is accepted for recognition medical care, sho dіє on thiazide receptor, How, how important it is, to be found on the Na-Cl symporter.

List of drugs in Europe

Europe has a wider range of such preparations:

• Lozol generic: indapamide
• Thalitone generic: chlorthalidone
• Zaroxolyn generic: metolazone
• Aquatensen generic: methyclothiazide
• Aquazide H
• Diuril generic: chlorothiazide
• Diuril Sodium generic: chlorothiazide
• Enduron generic: methyclothiazide
• Esidix generic: hydrochlorothiazide
• microzide generic: hydrochlorothiazide
• Mycrox generic: metolazone
• Naturetin generic: bendroflumethiazide
• Saluron generic: hydroflumethiazide
• Renese generic: polythiazide

For deakim tributes behind the cordon, the following preparations are actively vikoristovuyutsya:

• metolazone,
• hydroflumthiazide,
• benzthiazide,
• polyazide,
• methiclothiazide,
• bendroflumethiazide,
• trichloromethiazide,
• quinetazon,
• thienilic acid and in.

List of drugs in Russia and Belarus

(Indapamidum):

• Acripamide
• Acripamide retard
• Akuter-Sanovel
• Arindap
• Arifon
• Arifon retard
• Vero-Indapamide
• Indapamide
• Indapamide long richter
• Indapamid MV Shtada
• Indapamide retard
• Indapamide retard-OBL
• Indapamide retard-Teva
• Indapamide Sandoz
• Indapamide-OBL
• Indapamid-Verte
• Indapamid-Teva
• Indapres
• Indapsan
• Indap
• Indipam
• Indiour
• Inspra
• Ionic
• Ionic retard
• Ipres Long
• Lorvas
• Lorvas SR
• Pamid
• RavelSR
• Retapress
• SR-Indamed
• Tenzar

List of preparations from fluffy speech (Hydrochlorothiazidum):

• Hydrochlorothiazide
• Hydrochlorothiazide
• Hydrochlorothiazide-SAR
• Hypothiazide

Zvajayuchi on those that these preparations are widely used for the treatment of arterial hypertension, this list is far from complete, but to avenge the main trade names of these diseases.

Indication for ingestion of thiazide diuretics.

Thiazide diuretics in arterial hypertension

Thiazide diuretics were consistently successful in treating arterial hypertension from the moment they appeared on the market. This particular class of sechoginal products is an external stone in the treatment of hypertension. Even if it is not rich enough, that they victorious for jubilation, be it an ailment, they can boast of such a trivial term of zastosuvannya, but it should be noted both about the efficiency and about the safety of these chemical works. For example, hydrochlorothiazide It is the most popular diuretic in the world for the treatment of arterial hypertension. Thiazide diuretics reduce the risk of death, stroke, myocardial infarction and heart failure in arterial hypertension.

A lot of clinical references for the treatment of arterial hypertension are considered nutritional support of thiazide diuretics. The stinks of vicory are listed as the first line preparation in the USA (JNC VII) and recommended before the victorious line in Europe (ESC/ESH). Prote y 2011 The National Institute for Health Care in Great Britain (NICE) recommended blockers for the treatment of essential arterial hypertension calcium channels(BKK) as a preparation of the first line. However, it also indicates that thiazide diuretics can be used as a preparation for the first line in quiet depressions, as CCB is contraindicated, as the patient may have congestion or a high risk of developing heart failure. Thiazide diuretics were replaced in Australia with an angiotensin-converting enzyme (ACE) inhibitor through a shift to an increase in the risk of developing cerebrodiabetes 2 tips.

Thiazide diuretics in the cases of various trips

Thiazide diuretics are actively sought after for the treatment of the onset of nabryakiv:

• Tricks of the heart walk;

However, it is worth considering that in case of severe chronic heart failure (CHF), loop diuretics are significantly effective.

• Violations of the hepatic tract (with cirrhosis of the liver);
• Nirkov's outfits;

However, stench is not effective in case of severe nirk deficiency - with reduced glomerular filtration less than 30-40 milliliters per flu. Vinyatkom є metolazoneі indapamide through the dodatkove mіsce diї in the proximal tubules.

• Nabryaki with trivial recognition of glucocorticoids.

Indications associated with enhanced calcium reabsorption

Prevention of stone-setting at nirkah

Thiazide diuretics change the excretion of calcium from the stomach for increased reabsorption. Strengthening the reabsorption of calcium to kill them brown in the prevention of the adoption of calcium stones in nirkah, the concentration of calcium in the Nirkov tubules decreases

Thiazide diuretics and osteoporosis

This effect is also associated with a positive calcium balance and a decrease in the frequency of fractures in patients with osteoporosis. The mechanism for the development of this effect in the attack: thiazide diuretics stimulate the differentiation of osteoblasts and formation bone tissue. Zavdyaki tsyumu stink improve the progression of osteoporosis.

Zavdyaki zdatnostі zatrimuvat calcium in the body thiazide diuretics vykoristovuyutsya when likuvanni:

• Sick Dent;
• Hypocalcemia;
• Nephrolithiasis;
• Destroyed by bromide;

Thiazide diuretics in nephrogenic non-cucrous diabetes

Thiazide diuretics are the main agents in the treatment of nephrogenic non-cancerous diabetes. Scattered changes in the volume of circulating blood (BCC) lead to increased water reabsorption in the proximal tubules of the nephron.

Pharmacokinetics of thiazide diuretics

Thiazide diuretics, cream chlorthalidone, well absorbed in the intestinal tract (GIT) and intensively metabolized in the liver. Chlorthiazide through the trash in the slunk-intestinal tract, it is prescribed in equally large doses and is the only representative of the "thiazide diuretics" group, which can be administered parenterally.

Diya chlorthalidone nastaє povіlno through povіlne vmoktuvannia. Diuretics bind directly to blood plasma proteins and therefore they are consumed in the lumen of the tubules not through glomerular filtration, but through anion transport mechanism.

Drug interactions with thiazide diuretics

Thiazide diuretics help loop diuretics, vitamin D, cardiac glycosides, diazoxide, lithium preparations, anesthetics A relieve thiazide diuretics and insulin, sucrose-lowering similar sulfanyl compounds, anticoagulants, uricosuric diseases in treating gout.

Most unsafe thiazide diuretics in combination with quinidine through those that are on the face of hypokalemia (one of the side effects of administering thiazide diuretics, we say more about it below) quinidine may be unsafe for the life of mucosal arrhythmias.

The effect of thiazide diuretics is reduced with their combination with non-steroidal antiseptic drugs (NPZZ) and lipid-lowering ion-exchange cationic resins.

With the combination of thiazide diuretics with glucocorticoids, there is a risk of hypokalemia.

Mechanism of thiazide diuretics

Members of this class of sechoginic agents are similar to benzothiadiazine. The term "thiazide" is also often used for preparations with a similar effect, so as not to change the thiazide chemical structure. For example, chlortalidone and metolazone. It is better for agents to name thiazide-like diuretics.

Benzothiadiazine - father's structure of the class of molecules of thiazide diuretics

The mechanism of diuretics of thiazide diuretics in decreased arterial pressure remains unchanged. With the introduction of thiazides, there is a decrease in the pressure on the chest, an increase in diuresis, a change in plasma volume, and a decrease in cardiac output. Tsіkavim is the fact that with constant zastosuvanni thiazide diuretics reduce the pressure reach by way of lowering the peripheral support (to cause vasodilation). The mechanism for the development of this effect is unknown. Also, thiazide diuretics control arterial pressure, often by inhibiting the reabsorption of Na, K and Cl.

For use in loop diuretics and thiazide diuretics increase calcium reabsorption in the distal tubules of the nephron. With a reduced sodium concentration in the epithelial cells of the thiazide tubule, it is possible to increase the activity of the Na-Ca antiporter.

An antiporter is a cell channel in cellular membranes, which promotes the transport of speech through the membrane.

This makes it easier to transfer Ca from epithelial cells to nirk interstitial tissue. By itself, rux Ca changes the concentration of intracellular Ca, which allows Ca to diffuse even more from the lumen of the tubules in the epithelial clitinum through the apical Ca selective channels (TRPV5). In other words, a change in the concentration of Ca in the clitinum will increase the destructive force for the reabsorption of iodine from the lumen of the tubule to the nephron.

Thiazide diuretics also increase the reabsorption of Ca by an additional mechanism, in which case the reabsorption of Na and Ca in the proximal tubules leads to a change in the concentration of Na. Part of this reaction is observed to increase the level of parathyroid hormone.

The sechoginal effect of thiazide diuretics is significantly weaker, lower in loop diuretics, develops more, prote is more trivalym.

Thiazide diuretics and breast milk

Thiazide diuretics penetrate breast milk and may alter its production. That is why it is necessary to protect mothers who are in good health.

Contraindications before congestion of thiazide diuretics

Thiazide diuretics are absolutely contraindicated in advanced illnesses:

• Hypotension;
• Allergic reaction to the drug;
• Gout;
• Nir's deficiency;
• Lithium therapy;
• Hypokalemia;
• Might help you get over your diabetes.

Thiazide diuretics reduce the clearance of sicic acid, so stench competes with it for the same transporter, so stink increase the level of sechoic acid in the blood. Also, their traces of protection are recognized in patients with gout or hyperuricemia.

Post-stopping of thiazide diuretics can lead to hyperglycemia. Thiazide diuretics may cause before the body uses up potassium, at your own saving money Ca.

Thiazide diuretics can change placental perfusion and negatively affect the placenta, so the next unique date I will receive the next hour of vacancy.

Side effects of thiazide diuretics

Thiazide diuretics have the following side effects:

• Hyperglycemia;
• Hyperuricemia;
• hypokalemia (mechanism for development of descriptions below);
• Hyponatremia;
• Hypomagnesium;
• Hypocalciuria;
• Hyperuricemia, although gout rarely develops. In women, the risk is smaller, lower in men;
• Impaired ICT: nausea, anorexia, diarrhea, cholecystitis, pancreatitis, abdominal pain, constipation;
• Hyperlipidemia. Increased level of cholesterol in blood plasma by 5-15% and increased level of lipoproteins in the low blood pressure (LPDN) and triglycerides (TG). In general, the risk of developing atherosclerosis is relatively small;
• Damage to the central nervous system(CNS): weakness, xanthopsia, increased volume, paresthesia. Trapleyayutsya rarely;
• Impotence develops in 10% of people through a decrease in the duty of the body in the body;
• Allergic reactions. Cross-over allergy is suspected from the sulfanilamide group;
• Photosensitivity and dermatitis are sometimes suspected, and rarely - thrombocytopenia, hemolytic anemia and hostria necrotizing pancreatitis.

Mechanisms of hypokalemia

It appears that thiazide diuretics cause hypokalemia. Some of the mechanisms for the development of hypokalemia when taking thiazide diuretics (to reduce the concentration of potassium in plasma):

Activation of the renin-angiotensin-aldosterone system through sechogenetic hypovolemia: the body reacts to a decrease in the level of rіdini in the body and starts to increase aldosterone, which stimulates Na / K exchange, which leads to the consumption of potassium. As a result, ACE inhibitors, such as angiotensin 2, are often used in combination with thiazide diuretics to combat hypokalemia. The correct combination of doses allows you to successfully reach the target.

Decreased concentration Before the cut in the process of increasing diuresis, a greater gradient K from clitin at the cut. Potassium is taken in through potassium channels, such as ROMK. Vіdbuvaєtsya tse for the help of passive diffusion.