Potassium Sparing Diuretics

The most common medications of this subclass are spironolactone, triamterene, and amiloride. Spironolactone, a competitive inhibitor of aldosterone, acts to allow potassium retention while inducing sodium and water excretion. Triamterene has direct effects on the renal tubule to inhibit sodium exchange for potassium and hydrogen. Amiloride's mechanism of action, also independent of aldosterone, is to promote potassium retention in exchange of sodium and water. Volume depletion, hyperkalemia, hyponatremia, and hypochloremia are common manifestations of toxicity for this class of medication. Treatment for potassium-sparing diuretic toxicity is directed at maintaining intravascular volume, repleting sodium, and reversing the hyperkalemia. Hypotension is best initially treated with intravenous fluids, usually normal saline. If hypotension is persistent, a vasopressor such as dopamine is warranted. The most serious manifestations of hyperkalemia include neurologic and cardiovascular dysfunction. Treatment of hyperkalemia should remain a priority, and can be serious enough to warrant dialysis.

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