Furosemide-Induced Reduction in Ionized Calcium in Hypoparathyroid Patients

Gabow, Patricia A.; Hanson, Thomas J.; Popovtzer, Mordecai M.; Schrier, Robert W.

doi:10.7326/0003-4819-86-5-579

Cited by 23 publications

(12 citation statements)

References 10 publications

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“…Conflicting results have been reported on the long-term effects of LD on the 24 h renal calcium excretion. Some have reported an increased calcium excretion during the first days of treatment with a subsequent return to pretreatment levels during continued therapy [17][18][19], whereas others have found a persistent increased renal calcium excretion during long-term treatment [2,5,20]. Our findings support an increased renal calcium excretion in subjects on long-term treatment with LD.…”

Section: Calcitropic Hormones and Biochemical Bone Markerssupporting

confidence: 80%

Effects of long‐term treatment with loop diuretics on bone mineral density, calcitropic hormones and bone turnover

Rejnmark

Vestergaard

Heickendorff

et al. 2005

Journal of Internal Medicine

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Abstract. Rejnmark L, Vestergaard P, Heickendorff L, Andreasen F, Mosekilde L (Aarhus University Hospital and Aarhus University, Aarhus, Denmark). Effects of long-term treatment with loop diuretics on bone mineral density, calcitropic hormones and bone turnover. J Intern Med 2005; 257: 176-184.Background. Loop diuretics (LD) are widely used in the treatment of cardiovascular diseases and disorders with fluid accumulation. LD are known to increase renal calcium losses and may thereby affect calcium homeostasis and bone metabolism. Objective. We studied to what extent long-term treatment with LD affects calcium homeostasis and bone metabolism. Design and subjects. In a cross-sectional design we compared 140 postmenopausal women treated with a LD for more than 2 years with 140 age-matched women not in diuretic therapy. Results. Treatment with LD was associated with significantly increased urinary calcium, plasma parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D levels. Per 40 mg day )1 of furosemide,

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Section: Calcitropic Hormones and Biochemical Bone Markerssupporting

confidence: 80%

Effects of long‐term treatment with loop diuretics on bone mineral density, calcitropic hormones and bone turnover

Rejnmark

Vestergaard

Heickendorff

et al. 2005

Journal of Internal Medicine

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“…Since furosemide is an ex tremely rapidly acting drug, it is possible that we have missed a transient hypocalcemia at the peak of the daily response. Gabowet al [13] reported that furosemide-induced hypercalciuria could aggravate hypocalcemia in patients with hypoparathyroidism. Therefore, in the nor mal subjects, the secondary hyperparathyroidism appar ently compensates for the urinary calcium loss, leading to the normal level of serum calcium.…”

Section: Discussionmentioning

confidence: 99%

Effects of Oral Furosemide and Salt Loading on Parathyroid Function in Normal Subjects

Fujita

Chan

Bartter

1984

Nephron

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With oral furosemide administration and salt loading, urinary calcium was significantly increased in 8 normal subjects, accompanied by parallel natriuresis. In spite of the excessive calcium loss in the urine, total and ionized serum calcium remained unchanged. All subjects had significant increases in nephrogenous cyclic AMP, suggesting that parathyroid activity is elevated in subjects with furosemide-induced hypercalciuria. With furosemide, fecal calcium was significantly decreased, and resultantly, there was no significant change in the cumulative calcium balance. It is suggested that urinary calcium loss with furosemide is compensated for by secondary hyperparathyroidism via increased intestinal calcium absorption in order to maintain serum calcium at a normal level. The experimental model thus mimics the condition of the renal type of idiopathic hypercalciuria.

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“…Although the compensatory release of parathyroid hormone may attenuate urinary calcium and magnesium excretion [50][51][52][53][54], hypercalciuria is usually persistent. Chronic hypercalciuria may lead to metabolic bone disease, as bone is demineralized to maintain normal serum calcium levels [55].…”

Section: Adverse Effectsmentioning

confidence: 99%

The clinical pharmacology of loop diuretics in the pediatric patient

Eades

Christensen

1998

Pediatric Nephrology

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The loop diuretics furosemide and bumetanide are frequently employed in the pediatric population for the management of fluid overload in both acute and chronic disease states. They act mainly by inhibiting sodium reabsorption in the nephron at the thick ascending limb of Henle's loop. Important pharmacokinetic differences between adults and infants include a reduced clearance and prolonged half-life, that may cause accumulation of these agents to potentially toxic levels if dosing intervals are not adjusted. Unfortunately, little is known about the time required for maturation of loop diuretic elimination in older infants, children, and adolescents. Similar to adults, limited pharmacodynamic evidence in neonates suggests that a maximally efficient diuretic dose exists. Increasing the diuretic dose beyond this maximum does not offer further benefit, but may increase the risk of toxicity. Common problems encountered in the pediatric patient as well as in adults are loop diuretic tolerance and resistance. Loop diuretic dosing strategies aimed at overcoming these phenomena include administration by continuous infusion, coadministration with albumin, and coadministration with metolazone or thiazides. This article reviews the pharmacology, pharmacokinetics, and pharmacodynamics of furosemide and bumetanide in pediatric patients. A better understanding of the clinical pharmacology of the loop diuretics should aid clinicians in the development of dosing regimens aimed at producing adequate diuresis without promoting excessive diuretic tolerance.

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Furosemide-Induced Reduction in Ionized Calcium in Hypoparathyroid Patients

Cited by 23 publications

References 10 publications

Effects of long‐term treatment with loop diuretics on bone mineral density, calcitropic hormones and bone turnover

Effects of long‐term treatment with loop diuretics on bone mineral density, calcitropic hormones and bone turnover

Effects of Oral Furosemide and Salt Loading on Parathyroid Function in Normal Subjects

The clinical pharmacology of loop diuretics in the pediatric patient

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