This document discusses diuretics and electrolyte balance. It defines diuretics as substances that increase urine output by decreasing tubular reabsorption or increasing tubular secretion. The normal physiology of urine formation is described, including the roles of the nephron and glomerular filtration rate. The document outlines the major classes of diuretics and their mechanisms of action, including how they inhibit reabsorption at different sites of the nephron. Potential side effects and drug interactions of diuretics are also summarized.

1. Diuretics and Electrolyte Balance
DEEPAK KUMAR SAHEL
ASSISTANT PROFESSOR
DEPT. OF PHARMACOLOGY
ISF COLLEGE OF PHARMACY
WEBSITE: - WWW.ISFCP.ORG
EMAIL: Deepakisfcp10@gmail.Com
ISF College of Pharmacy, Moga
Ghal Kalan,nGT Road, Moga- 142001, Punjab, INDIA
Internal Quality Assurance Cell - (IQAC)

2. Introduction
• Diuretics are the chemical substances which increase urine output by two ways.
 By decreasing tubular reabsorption
 By increasing tubular secretion
• Diuretics, also called water pills, are medications designed to increase the amount
of water and salt expelled from the body as urine
2

3. Normal Physiology of Urine Formation 3
• Kidney is the main organ which regulate urine formation in body
• Nephron is the smallest structural and functional unit of kidney
• There are approx. 1,000,000 nephron in one human kidney
• Nephron act as a filter media in the process of urine formation
• Kidney is the main organ in regulation of electrolyte balance in the body

4. Parts of Nephron 4
These are the five main parts of a nephron
 Bowen's capsule
 Proximal convoluted tubule
 Loop of Henle
 Distal convoluted tubule
 Collecting duct

5. Glomerular Filtration Rate (GFR) 5
• Its is the normal rate by which filtration of blood is carried out by glomerular in
Bowen's capsule .
• The normal GFR is 130 ml/min
• There are various markers which are used to determine the GFR value such as:
inulin
• GFR defines the normal functioning of kidney

6. Normal Physiology of Urine Formation 6
Bowman’s
capsule
Glomerulus
Loop of Henle
Collecting Duct
DCT
PCT

7. Various site for reabsorption in nephron 7
There are four major site in nephron through which reabsorption of
glomerular filtered blood.
 Sodium/hydrogen Pump
 2 Chloride/Hydrogen/Potassium Pump
 Sodium/Chloride Pump
 Sodium/Potassium Pump

8. Major classes of Diuretics 8
1. Carbonic Anhydrase Inhibitors – Acetazolamide
2. High efficiency diuretics – Furosemide
3. Thiazide diuretics - Hydrochlorothiazide
4. Aldosterone antagonist - Spironolactone

9. Diuretics – Mechanism of Action 9
1. Carbonic Anhydrase Inhibitors – Acetazolamide
This class of drugs act on site I and inhibits the Na/H pump. This leads to
reduction of reabsorption of sodium.
2. High efficiency diuretics – Furosemide
This class of drugs act on site II and inhibits the 2Cl/K/Na pump and leads to
reduction of reabsorption

10. 10
Loop of Henle
Carbonic
anhydrase
Na
H
H+HCO2= H2CO
Aldosterone
Na
K
Collecting Duct
Acetazolamide
Furosemide
Thiazide
Spirenolectone

11. Diuretics – Mechanism of Action 11
3. Thiazide diuretics - Hydrochlorothiazide
These substance act on site III and inhibits the Na/Cl pump, leads to
reduction of reabsorption.
4. Aldosterone antagonist - Spironolactone
These substance act on site IV and inhibits the activity of Aldosterone,
aldosterone regulate Na/K pump.

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Any time you begin a new medication, you should tell your doctor about any
other drugs, supplements, or herbs you’re taking. Be sure to tell your doctor if
you take any medications that might interact with a diuretic. These include:
 Cyclosporine
 Antidepressants such as fluoxetine and venlafaxine
 Lithium
 Digoxin
 Other drugs for high blood pressure
Drug interactions

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The more common side effects of diuretics include:
•Too little potassium in the blood
•Too much potassium in the blood (for potassium-sparing diuretics only)
•Low sodium levels
•Headache
•Dizziness
•Thirst
Side Effects of Diuretics

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•Increased blood sugar
•Muscle cramps
•Increased cholesterol
•Skin rash
•Gout
•Diarrhea
Side Effects of Diuretics

15. 15Uses of Diuretics
Diuretics are used in following physiological conditions
 Hypertension
 Angina Pectoris
 CHF

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THANK YOU

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