jonathon
Forum Senior
Topics: 25
Posts: 62
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Q. A woman with sarcoidosis or with hypercalcemia (there are a thousand ways to ask this concept) enters your clinic, which is the diuretic of choice?
A. Furosemide, NOT thiazides or mannitol, or acetazolamide
WHY can't you give thiazides, mannitol or acetazolamide
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| Doc2378
Forum Guru
Topics: 46
Posts: 688
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Furosemide is the DOC as it decreases serum calcium levels...while others (eg: thiazides) cause hypercalcemia...
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| cyra
Moderator
Topics: 29
Posts: 844
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You want to treat the hypercalcemia....one way of doing that would be increasing the urinary excretion of calcium
Furosemide is a loop diuretic...it blocks the Na-K-2Cl channel.....which in turn diminishes the positive gradient across the tubular cells which would normally allow reabsorption of Ca and Mg...and so there would be excretion of Ca...
Thiazides on the other hand...act on the DCT cells...where they inhibit the Na-Cl channels....intacellular a concentration decreases and the Na-Ca channles start working to bring in more Na into the cell...and as a result more Ca is reabsorbed...so this would worsen the hypercalcemia....
Mannitol and Acetazolamide have no beneficial effect in T/M of hypercalcemia....
It would help if you look at diagrams of mechanism of action of diuertics...
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