Abstract
Combination therapy with a loop diuretic and an aldosterone antagonist can produce normokalemic hypochloremic alkalosis, a complication not previously documented in the literature. This report describes 74 patients who had severe congestive heart failure treated with a combination of furosemide and spironolactone in whom this complication developed. Acetazolamide corrected the metabolic abnormality. The combination of furosemide and spironolactone with intermittent courses of acetazolamide was very effective in the treatment of severe congestive heart failure complicated by normokalemic hypochloremic alkalosis.
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- BELSKY H. Use of a new oral diuretic, diamox, in congestive heart failure. N Engl J Med. 1953 Jul 23;249(4):140–143. doi: 10.1056/NEJM195307232490404. [DOI] [PubMed] [Google Scholar]
- BUTCHER W. A., WAKIM K. G., ESSEX H. E., PRUITT R. D., BURCHELL H. B. The effect of changes in concentration of cations on the electrocardiogram of the isolated perfused heart. Am Heart J. 1952 Jun;43(6):801–814. doi: 10.1016/0002-8703(52)90235-4. [DOI] [PubMed] [Google Scholar]
- Bushinsky D. A., Gennari F. J. Life-threatening hyperkalemia induced by arginine. Ann Intern Med. 1978 Nov;89(5 Pt 1):632–634. doi: 10.7326/0003-4819-89-5-632. [DOI] [PubMed] [Google Scholar]
- CASEY T. H., SUMMERSKILL W. H., ORVIS A. L. BODY AND SERUM POTASSIUM IN LIVER DISEASE. I. RELATIONSHIP TO HEPATIC FUNCTION AND ASSOCIATED FACTORS. Gastroenterology. 1965 Feb;48:198–207. [PubMed] [Google Scholar]
- Dettli L., Spring P. Therapy with combinations of diuretic agents: comparative studies. Ann N Y Acad Sci. 1966 Nov 22;139(2):471–480. doi: 10.1111/j.1749-6632.1966.tb41221.x. [DOI] [PubMed] [Google Scholar]
- EARLEY L. E., ORLOFF J. THIAZIDE DIURETICS. Annu Rev Med. 1964;15:149–166. doi: 10.1146/annurev.me.15.020164.001053. [DOI] [PubMed] [Google Scholar]
- FRIEDBERG C. K., HALPERN M., TAYMOR R. The effect of intravenously administered 6063, the carbonic anhydrase inhibitor, 2-acetylamino-1, 3, 4-thiadiazole-5-sulfonamide, on fluid and electrolytes in normal subjects and patients with congestive heart failure. J Clin Invest. 1952 Dec;31(12):1074–1081. doi: 10.1172/JCI102702. [DOI] [PMC free article] [PubMed] [Google Scholar]
- FRIEDBERG C. K., TAYMOR R., MINOR J. B., HALPERN M. The use of diamox, a carbonic anhydrase inhibitor, as an oral diuretic in patients with congestive heart failure. N Engl J Med. 1953 May 21;248(21):883–889. doi: 10.1056/NEJM195305212482102. [DOI] [PubMed] [Google Scholar]
- GETTES L. S., SURAWICZ B., SHIUE J. C. Effect of high K, and low K quinindine on QRS duration and ventricular action potential. Am J Physiol. 1962 Dec;203:1135–1140. doi: 10.1152/ajplegacy.1962.203.6.1135. [DOI] [PubMed] [Google Scholar]
- Greenblatt D. J., Koch-Weser J. Adverse reactions to spironolactone. A report from the Boston Collaborative Drug Surveillance Program. JAMA. 1973 Jul 2;225(1):40–43. doi: 10.1001/jama.225.1.40. [DOI] [PubMed] [Google Scholar]
- Hook J. B., Williamson H. E. Influence of probenecid and alterations in acid-base balance of the saluretic activity of furosemide. J Pharmacol Exp Ther. 1965 Sep;149(3):404–408. [PubMed] [Google Scholar]
- KASSIRER J. P., BERKMAN P. M., LAWRENZ D. R., SCHWARTZ W. B. THE CRITICAL ROLE OF CHLORIDE IN THE CORRECTION OF HYPOKALEMIC ALKALOSIS IN MAN. Am J Med. 1965 Feb;38:172–189. doi: 10.1016/0002-9343(65)90172-5. [DOI] [PubMed] [Google Scholar]
- Kassirer J. P., Harrington J. T. Diuretics and potassium metabolism: a reassessment of the need, effectiveness and safety of potassium therapy. Kidney Int. 1977 Jun;11(6):505–515. doi: 10.1038/ki.1977.67. [DOI] [PubMed] [Google Scholar]
- Laragh J. H., Cannon P. J., Stason W. B., Heinemann H. O. Physiologic and clincical observations on furosemide and ethacrynic acid. Ann N Y Acad Sci. 1966 Nov 22;139(2):453–465. doi: 10.1111/j.1749-6632.1966.tb41219.x. [DOI] [PubMed] [Google Scholar]
- Lawson D. H. Adverse reactions to potassium chloride. Q J Med. 1974 Jul;43(171):433–440. [PubMed] [Google Scholar]
- Liddle G. W. Aldosterone antagonists and triamterene. Ann N Y Acad Sci. 1966 Nov 22;139(2):466–470. doi: 10.1111/j.1749-6632.1966.tb41220.x. [DOI] [PubMed] [Google Scholar]
- MAREN T. H. Pharmacological and renal effects of diamox (6063), a new carbonic anhydrase inhibitor. Trans N Y Acad Sci. 1952 Dec;15(2):53–53. doi: 10.1111/j.2164-0947.1952.tb01153.x. [DOI] [PubMed] [Google Scholar]
- MUDGE G. H., WEINER I. M. The mechanism of action of mercurial and xanthine diuretics. Ann N Y Acad Sci. 1958 Feb 3;71(4):344–354. doi: 10.1111/j.1749-6632.1958.tb46761.x. [DOI] [PubMed] [Google Scholar]
- RELMAN A. S., LEAF A., SCHWARTZ W. B. Oral administration of a potent carbonic anhydrase inhibitor (Diamox). II. Its use as a diuretic in patients with severe congestive heart failure. N Engl J Med. 1954 May 13;250(19):800–804. doi: 10.1056/NEJM195405132501902. [DOI] [PubMed] [Google Scholar]
- SCHWARTZ W. B., RELMAN A. S., LEAF A. Oral administration of a potent carbonic anhydrase inhibitor (diamox). III. Its use as a diuretic in patients with severe congestive heart failure due to cor pulmonale. Ann Intern Med. 1955 Jan;42(1):79–89. doi: 10.7326/0003-4819-42-1-79. [DOI] [PubMed] [Google Scholar]
- SCHWARTZ W. B. The role of electrolyte balance in the response to mercurial diuretics in congestive heart failure. Bull New Engl Med Cent. 1950 Dec;12(6):213–218. [PubMed] [Google Scholar]
- SCHWARTZ W. B., WALLACE W. M. Electrolyte equilibrium during mercurial diuresis. J Clin Invest. 1951 Oct;30(10):1089–1104. doi: 10.1172/JCI102529. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SELDIN D. W. Management of congestive heart failure; management designed to avoid serious disturbances of electrolyte and water balance. AMA Arch Intern Med. 1955 Mar;95(3):385–399. doi: 10.1001/archinte.1955.00250090023005. [DOI] [PubMed] [Google Scholar]
- ST. GEORGE S., FREED S. C., ROSENMAN R. H., WINDERMAN S. Influence of potassium deprivation and adrenalectomy on potassium concentration of the myocardium. Am J Physiol. 1955 Jun;181(3):550–552. doi: 10.1152/ajplegacy.1955.181.3.550. [DOI] [PubMed] [Google Scholar]
- Schwartz W. B., Van Ypersele de Strihou, Kassirer J. P. Role of anions in metabolic alkalosis and potassium deficiency. N Engl J Med. 1968 Sep 19;279(12):630–639. doi: 10.1056/NEJM196809192791204. [DOI] [PubMed] [Google Scholar]
- Stason W. B., Cannon P. J., Heinemann H. O., Laragh J. H. Furosemide. A clinical evaluation of its diuretic action. Circulation. 1966 Nov;34(5):910–920. doi: 10.1161/01.cir.34.5.910. [DOI] [PubMed] [Google Scholar]
- WESTON R. E., ESCHER D. J. W., GROSSMAN J., LEITER L. Mechanisms contributing to unresponsiveness to mecurial diuretics in congestive failure. J Clin Invest. 1952 Oct;31(10):901–910. doi: 10.1172/JCI102678. [DOI] [PMC free article] [PubMed] [Google Scholar]