During the peak effect of the loop diuretics, urine flow is greatly augmented, as is the excretion of Na+ and Cl", corresponding to as much as 20 to 30% of their filtered load. K+ loss also occurs as an indirect effect of the large Na+ load reaching the distal tubules and is 2 to 5 times above normal levels of K+ excretion. With low or moderately effective doses, these drugs do not appreciably affect HCO3" or H+ excretion.
Furosemide (Lasix), torsemide (Demadex), and bumetanide (Bumex) possess some carbonic anhydrase inhibiting activity (about one-tenth that of chloroth-iazide). This property may account for the increased bicarbonate and phosphate excretion seen after large doses of these diuretics. The elevated HCO3" loss probably indicates some proximal tubular effects for furosemide and bumetanide.
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