📌Diuretics⚠️

📍Mannitol - Pulmonary edema - osmotic diuretic transiently expands intravascular volume before diuresis begins - fluid shifts from interstitium to vasculature - pulmonary capillary pressure rises - worsens pulmonary congestion; cohtraindicated in de pulmonary edema for this reason
📍Loop diuretics - Hepatic encephalopathy - aggressive diuresis in cirrhotic ascites - hypokalemia - kidneys compensate by retaining K* in exchange for H+
- metabolic alkalosis - alkaline pH favours NH3 (uncharged) over NHa* - ammonia crosses BBB more readily - encephalopathy worsens; the diuretic treating ascites precipitates brain dysfunction
📍Thiazides - Hyperuricemia/Gout - reduce renal uric
acid excretion via competition for proximal tubular organic acid transporter - urate retained - serum uric acid rises - precipitates acute gout attack; treating hypertension with a drug that triggers a painful complication in susceptible patients
📍Acetazolamide - Nephrolithiasis (calcium
phosphate stones) - bicarbonaturia alkalinises urine - calcium phosphate precipitates in alkaline urine - stone formation promoted; used for uric acid stones (alkalinisation helpful) but worsens calcium phosphate stones - same mechanism helping one stone type actively promoting another

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