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1. Treat edematous patients with heart failure or CKD with a loop diuretic (eg. Frusemide).

2. Treat patients with hypokalemia with spironolactone.

3. Diuretic-induced hypokalemia can be dangerous in patients with cardiac problems and cirrhosis because of the potential for arrhyth­mias (especially if on digoxin) and hepatic coma.

4. Because higher doses only increase side effects, use the lowest diuretic dose needed to achieve the desired effect.

5. In HF & cirrhotic patients, it's best to keep the K > 4 with supplementation or K-sparing drugs.

6. Thiazide diuretics can produce severe hyponatremia in patients with poor solute intake, particularly the elderly.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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