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Toxicity:

•    Hypokalemia metabolic alkalosis:

o increased delivery of NaCl and water to the collecting duet inereases potassium and proton secretion— causing a hypokalemic metabolic alkalosis o in managed by potassium replacement and by ensuring adequate fluid intake

•    Ototoxicity:

o dose-related hearing loss (in usually reversible) o morę common:

■    with decreased renal function

■    with concurrent administration of other ototoxic dmgs such as aminoglycosides

•    Hyperuricemia:

o may cause gout

o loop diuietics cause increased uric acid reabsorption in the proximal tubule. secondary to hypovolemic States.

•    Hypomagnesemia: loop diuretics cause:

1.    reduction in sodium chloride reabsorption

2.    decreases nomial lumen-positive potential (secondary to potassium recycling)

3.    Positive lumen potential: drives divalent cationic reabsorption (calcium magnesium)

4.    Therefore, loop diuretics inerease magnesium and calcium excretion.

■    hypomagnesemia may occur in sonie patients.

■    reversed by orał magnesium administration

•    Allergic reactions:

o furosemide: skin rash, eosinophilia, interstitial nephritis(less often)

•    Other toxicities:

o Dehydration (may be severe)

o h>ponatremia (less common than with thiazides thought may occur in patients who increased water intake in response to a hypovolemic thirst)