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| Diuretics |
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| Loop Diuretics |
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| Depletions |
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| Calcium |
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Osteoporosis (bone loss) is the primary disease
associated with long-term calcium deficiency; it may be
associated with bone pain and spinal deformity. Depleted
levels can also cause muscle cramps, irregular
heartbeat, and depression.
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| Magnesium |
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Magnesium deficiency affects calcium and vitamin D
levels in the body and may be associated with muscle
cramps, heart irregularities, high blood pressure,
diabetes, and osteoporosis (bone loss).
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| Phosphorus |
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Although phosphorus deficiency is rare, long-term low
levels are associated with muscle weakness, bone pain,
mental confusion, loss of appetite, anemia, increased
susceptibility to infection, respiratory difficulties,
seizures, and even death.
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| Potassium |
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Symptoms of deficiency include loss of appetite,
nausea, drowsiness, feelings of apprehension, excessive
thirst, irrational behavior, fatigue, muscle pain and
weakness (usually of the lower limbs); severe cases may
lead to irregular heartbeat.
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| Vitamin
B1 (Thiamine) |
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Symptoms of depleted levels of thiamine include
weakness, fatigue, anorexia, constipation, memory loss,
confusion, and depression. Deficiency may lead to
beriberi, a condition characterized by inflammation of
nerves, heart irregularities, and fluid retention.
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| Vitamin
B6 (Pyridoxine) |
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Symptoms of vitamin B6 deficiency may
include weakness, nervousness, insomnia, mental
confusion, irritability, and anemia. Long-term low
levels of this nutrient may also increase the risk of
heart disease as well as colon and prostate cancers.
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| Vitamin
C (Ascorbic Acid) |
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Vitamin C deficiency may include bruising, fever,
anemia, emotional changes, swollen and bleeding gums,
fatigue, lethargy, jaundice (yellowing of the skin and
eyes), increased susceptibility to infections, slow
wound healing, and swelling of the lower limbs. Severe
deficiency leads to scurvy, a disorder that affects
muscles and bones and is potentially fatal. However,
scurvy is rare these days because of the wide
availability of vitamin C from dietary sources.
Supporting Research
Abrams J. Intramuscular bumetanide and furosemide in
congestive heart failure. J Clin Pharmacol.
1981;21:673-679.
Ames BN. Micronutrient deficiencies: A major cause of
DNA damage. Ann NY Acad Sci. 2000;889:87-106.
Brady JA, Rock CL, Horneffer MR. Thiamin status,
diuretic medications, and the management of congestive
heart failure. J Am Diet Assoc.
1995;95(5):541-544.
Carr AC, Frei B. Toward a new recommended dietary
allowance for vitamin C based on antioxidant and health
effects in humans. Am J Clin Nutr
1999;69:1086-1087.
Carriere S, Dandavino R. Bumetanide, a new loop
diuretic. Clin Pharm Ther. 1976;20:424-438.
Cashman K, Flynn A. Optimal nutrition: calcium,
magnesium and phosphorus. Proc Nutr Soc.
1999;58:477-487.
Covington T, ed. Nonprescription Drug Therapy
Guiding Patient Self-Care. St Louis, MO: Facts and
Comparisons; 1999:467-545.
Davies DL, Lant AF, Millard NR, Smith AJ, Ward JW,
Wilson GM. Renal action, therapeutic use, and
pharmacokinetics of the diuretic bumetanide. Clin
Pharmacol Ther. 1974;15:141-155.
Fujita T, Delea CS, Bartter FC. The effects of oral
furosemide on the response of urinary excretion of
cyclic adenosine monophosphate and phosphate to
parathyroid extract in normal subjects. Nephron.
1985;41(4):333-336.
Hines Burnham T, et al, eds. Drug Facts and
Comparisons. St. Louis, Mo:Facts and Comparisons;
2000:624-626.
Leary WP, Reyes AJ, Wynne RD, van der Byl K. Renal
excretory actions of furosemide, of hydrochlorothiazide
and of the vasodilator flosequinan in healthy subjects. J
Int Med Res. 1990;18:120-141.
Mydlik M, Derzslova K, Zemberova E, Rajnic A. [The
effect of furosemide on urinary excretion of oxalic
acid, vitamin C and vitamin B6 in chronic renal
failure.] Vnitr Lek. 1998;44(3):127-131.
National Research Council. Recommended Dietary
Allowances. 10th ed. Washington, DC:
National Academy Press; 1989.
Ogawa K, Hatano T, Yammoto M, Matsui N. Influence of
acute diuresis on calcium balance – a comparative
study of furosemide and azosemide. Int J Clin
Pharmacol, Ther, Toxicol. 1984;22(8):401-405.
Potts JT. Diseases of the parathyroid gland and other
hyper- and hypocalcemic disorders. In: Fauci AS,
Braunwald E, Isselbacher KJ, et al, eds. Harrison's
Principles of Internal Medicine. 14th ed.
New York: McGraw-Hill Companies Health Professional
Division; 1998:2241.
Quamme GA. Renal magnesium handling: new insights in
understanding old problems. Kidney Int.
1997;52(5):1180-1195.
Rastogi S, Bayliss JM, Nascimento L, Arruda JA.
Hyperkalemic renal tubular acidosis: effect of
furosemide in humans and in rats. Kidney Int.
1985;28(5):801-817.
Rieck J, Halkin H, Almog S, et al. Urinary loss of
thiamine is increased by low doses of furosemide in
healthy volunteers. J Lab Clin Med.
1999;134(3):238-243.
Ryan MP. Magnesium and potassium-sparing diuretics. Magnesium.
1986;5(5-6):282-292.
Seligmann H, Halkin H, Rauchfleisch S, et al.
Thiamine deficiency in patients with congestive heart
failure receiving long-term furosemide therapy: a pilot
study. Am J Med. 1991;91(2):151-155.
Warshaw BL, Anand SK, Kerian A, Lieberman E. The
effect of chronic furosemide administration on urinary
calcium excretion and calcium balance in growing rats. Pediatr
Res. 1980;14(10):1118-1121.
Wilson JD. Vitamin deficiency and excess. In: Fauci
AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's
Principles of Internal Medicine. 14th ed.
New York: McGraw-Hill Companies Health Professional
Division; 1998:483-485.
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| Review Date: October
2000 |
Reviewed By: All
depletions monographs have been reviewed by a team of
experts including Derrick M. DeSilva, Jr., MD, Raritan
Bay Medical Center, Perth Amboy, NJ; Jacqueline A. Hart,
MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor,
A.D.A.M., Inc., Boston, MA; John Hinze, PharmD, NMD,
Woodbine, IA; Ruth Marlin, MD, Medical Director and
Director of Medical Education, Preventive Medicine
Research Institute, Sausalito, CA; Brian T Sanderoff,
PD, BS in Pharmacy, Clinical Assistant Professor,
University of Maryland School of Pharmacy; President,
Your Prescription for Health, Owings Mills, MD; Leonard
Wisneski, MD, FACP, George Washington University,
Rockville, MD; Ira Zunin, MD, MPH, MBA, President and
Chairman, Hawaii State Consortium for Integrative
Medicine, Honolulu, HI.
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Copyright © 2004 A.D.A.M., Inc
The publisher does not
accept any responsibility for the accuracy of the
information or the consequences arising from the
application, use, or misuse of any of the information
contained herein, including any injury and/or damage to
any person or property as a matter of product liability,
negligence, or otherwise. No warranty, expressed or
implied, is made in regard to the contents of this
material. No claims or endorsements are made for any
drugs or compounds currently marketed or in
investigative use. This material is not intended as a
guide to self-medication. The reader is advised to
discuss the information provided here with a doctor,
pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including
package inserts) regarding dosage, precautions,
warnings, interactions, and contraindications before
administering any drug, herb, or supplement discussed
herein.
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