Which electrolyte disturbance is typically seen with loop diuretics?

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Multiple Choice

Which electrolyte disturbance is typically seen with loop diuretics?

Loop diuretics block the Na-K-2Cl transporter in the thick ascending limb, so more NaCl reaches the distal nephron. To reclaim that sodium, the collecting duct increases exchange: Na is reabsorbed while K and H are secreted into the urine. This leads to potassium loss (hypokalemia) and hydrogen ion loss (metabolic alkalosis). The diuretics also cause volume depletion, which triggers the renin-angiotensin-aldosterone system, further promoting potassium and hydrogen loss and sustaining the alkalosis—a situation known as contraction alkalosis. Additionally, calcium reabsorption in the thick ascending limb is reduced, increasing calcium excretion, so hypercalcemia is not expected. That’s why the typical disturbance is hypokalemia with metabolic alkalosis (contraction alkalosis).

Loop diuretics block the Na-K-2Cl transporter in the thick ascending limb, so more NaCl reaches the distal nephron. To reclaim that sodium, the collecting duct increases exchange: Na is reabsorbed while K and H are secreted into the urine. This leads to potassium loss (hypokalemia) and hydrogen ion loss (metabolic alkalosis). The diuretics also cause volume depletion, which triggers the renin-angiotensin-aldosterone system, further promoting potassium and hydrogen loss and sustaining the alkalosis—a situation known as contraction alkalosis. Additionally, calcium reabsorption in the thick ascending limb is reduced, increasing calcium excretion, so hypercalcemia is not expected.

That’s why the typical disturbance is hypokalemia with metabolic alkalosis (contraction alkalosis).

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