, Volume 1, Issue 2, pp 141–165 | Cite as

Diuretics II: Clinical Considerations

  • John L. Anderton
  • Priscilla Kincaid-Smith
Review Article


The successful use of diuretics depends upon a knowledge of their mode of action, their potency, and their side-effects. The four basic groups of diuretics which cover most situations are: (i) the thiazides, (ii) ethacrynic acid or frusemide, (iii) spironolactone or triamterene, (iv) mannitol.

The thiazides have a moderate diuretic action and are useful in any oedematous state where a gradual removal of salt and water is required. Mild to moderate cardiac, cirrhotic, and renal oedema respond well to thiazide administration, and the thiazides are useful in systemic hypertension, diabetes insipidus, and in the treatment of hypertension and oedema associated with pregnancy.

Ethacrynic acid and frusemide are potent diuretics and are useful in managing patients with severe resistant oedema, in acute left ventricular failure, in chronic renal failure when very high doses may be required, in eclampsia, and in the management of patients who have taken an overdose of drugs.

Spironolactone or triamterene are useful in conditions where there is hyperaldosteron-ism, particularly primary aldosteronism when surgery is not possible, and in cirrhosis. They are occasionally useful in cardiac and nephrotic oedema in association with other diuretics.

Mannitol is a useful osmotic diuretic particularly as a prophylactic agent against acute tubular necrosis and in the management of patients who have taken an overdose of drugs. Mannitol is occasionally useful in inducing a diuresis in patients with severe resistant oedema.

The side-effects of diuretic agents fall into two groups: (i) biochemical or metabolic effects shared by most diuretics and (ii) miscellaneous effects particular to individual diuretics. The biochemical disturbances include acute and chronic sodium depletion, due to the ingestion of diuretics while on a restricted sodium intake; chronic dilutional hyponatremia due to the overloading of the body with salt free fluids; hypokalemia due to the ingestion of diuretics without potassium supplements; and in the presence of renal failure, hyperkalemia due to the ingestion of potassium supplements, spironolactone or triamterene. Abnormalities in carbohydrate, uric acid and calcium metabolism are occasionally seen with most diuretics.

It should be remembered that the use of diuretic agents is only part of the total management of the patient, and that every attempt should be made to influence the primary pathology of the condition being treated.

Key Words

Diabetes insipidus Drug poisoning Drug reactions adverse Eclampsia pre-eclampsia Heart failure Hypertension Liver cirrhosis Nephrotic syndrome Pregnancy Renal failure 


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  1. Aperia, A.C.; Liebow, A.A., and Roberts, L.E.: Tubular sodium reabsorption and the regulation of renal haemodynamics. The effect of hypertonic saline infusion on renal vascular resistance. Acta Physiologica Scandinavica 75: 370–376 (1969).PubMedCrossRefGoogle Scholar
  2. Asatoor, A.M.; Galman, B.R.; Johnson, J.R., and Milne, M.D.: The excretion of dexamphetamine and its derivatives. British Journal of Pharmacology 24: 293–300 (1965).Google Scholar
  3. Assali, H.S.; Judd, L.; Mondz, N., and Dasgupta, K.: Diuretic effect of chlorothiazide in toxaemia of pregnancy. Journal of Laboratory and Clinical Medicine 52:423–436(1958).PubMedGoogle Scholar
  4. Barjon, P. et Pelissier, J.G.: Posologie, indications et effets secondaires de l’acide éthacrynique. Journal d’urologie et de néphrologie 72: 591–609 (1961).Google Scholar
  5. Barry, K.G.; Cohen, A., and Le Blanc, P.: Mannitolization. I. The prevention and therapy of oliguria associated with cross clamping of the abdominal aorta. Surgery 50:335–340(1961).PubMedGoogle Scholar
  6. Barry, K.G. and Malloy, J.P.: Oliguric renal failure. Evaluation and therapy by the intravenous infusion of mannitol. Journal of American Medical Association 179: 510–513(1962).CrossRefGoogle Scholar
  7. Bell, N.H.; Schedl, H.P., and Banter, T.C.: An explanation for abnormal water retention and hypo-osmolality in congestive heart failure. American Journal of Medicine 36: 351–360 (1964).PubMedCrossRefGoogle Scholar
  8. Bergentz, S.E.; Falkheden, T., and Olson, S.: Diuresis and urinary viscosity in dehydrated patients; influence of dextran-40,000 with and without mannitol. Annals of Surgery 161: 582–586(1965).PubMedCrossRefGoogle Scholar
  9. Biagi, R. W. and Bapat, B.N.: Frusemide in acute pulmonary oedema. Lancet 1: 849 (1967).PubMedCrossRefGoogle Scholar
  10. Boba, A.; Gainor, J., and Powers, S.R., Jr.: The influence of mannitol on water and electrolyte excretion following trauma. Surgery 52: 188–194 (1962).PubMedGoogle Scholar
  11. Brown, J.J.; Chinn, R.H.; Ferris, J.B.; Fraser, R.; Lever, A.F., and Robertson, J.I.S.: Spironolactone in hyperaldosteronism. British Medical Journal 4: 688 (1969).PubMedCrossRefGoogle Scholar
  12. Camishion, R.C. and Fishman, N.H.: Effect of mannitol on renal blood flow and cardiac output in haemorrhage shock. Circulation (supplement) 29: 130–134 (1964).Google Scholar
  13. Cannon, P.J.; Heinemann, H.O.; Stason, W.B., and Laragh, J.H.: Ethacrynic acid effectiveness and mode of diuretic action in man. Circulation 31: 5–18 (1965).PubMedCrossRefGoogle Scholar
  14. Cattan, R.; Vesin, P. et Liozin, F.: Résultats et indications de l’hydrochlorothiazide dans les odèmes. Bulletin of Society of Medicine (Paris) 75: 517–530 (1959).Google Scholar
  15. Cohen, A.B.: Hyperkalaemic effects of triamterene. Annals of Internal Medicine 65: 521–527 (1966).PubMedGoogle Scholar
  16. Coppage, W.S., Jr. and Liddle, G.W.: Mode of action and clinical usefulness of aldosterone antagonists. Annals of New York Academy of Science 88: 815–821 (1960).CrossRefGoogle Scholar
  17. Cox, J.R.; Davies-Jones, G.A.B., and Leonard, P.J.: Sodium content and urinary aldosterone excretion in patients with congestive heart failure before and after treatment and comparison with normal subjects undergoing salt restriction. Clinical Science 26: 177–184 (1964).PubMedGoogle Scholar
  18. Cranston, W.I. and Juel-Jensen, B.E.: The effects of spironolactone and chlorthalidone on arterial pressure. Lancet 1: 1161–1164 (1962).PubMedCrossRefGoogle Scholar
  19. Cutler, R.; Kleeman, CR.; Dowling, J.T., and Maxwell, M.H.: Physiological studies in a family with nephrogenic (vasopressin-resistant) diabetes insipidus (N.D.I.). Journal of Clinical Investigation 39: 980–990 (1960).Google Scholar
  20. Dawson, J.L.: Jaundice and anoxic renal damage: Protective effect of mannitol. British Medical Journal 1: 810–811(1964).PubMedCrossRefGoogle Scholar
  21. Demartini, F.E.; Briscoe, A.M., and Ragan, C.: Effect of ethacrynic acid on calcium and magnesium excretion. Proceedings of Society Experimental Biology and Medicine 124: 320–324 (1967).Google Scholar
  22. Derot, M. et Legroin, M.: La néphropathie hémoly tique post-transfusionnelle: Etude critique de 36 observations. Bulletins et mémoires de la Société médicale des hôpitaux de Paris 70: 1007–1013 (1954).PubMedGoogle Scholar
  23. Dettli, L. and Spring, P.: Therapy with combinations of diuretic agents. Annals of New York Academy of Science 139:471–480 (1966).CrossRefGoogle Scholar
  24. De Wordener, H.E.: Control of sodium reabsorption. British Medical Journal 3: 611–616 and 676-683 (1969a).CrossRefGoogle Scholar
  25. De Wordener, H.E.; Clarkson, EM., and Ford, J.: Potassium supplements. British Medical Journal 4: 168 (1969b).CrossRefGoogle Scholar
  26. Dige-Petersen, H.: Ethacrynic acid and carbohydrate metabolism. Nordisk Medicin 75: 123–125 (1966).PubMedGoogle Scholar
  27. Dollery, C.T.; Emslie-Smith, D., and Muggleton, D.F.: Actions of chlorothiazide in hypertension. Proceedings of Royal Society of Medicine 53: 592–594 (1960).Google Scholar
  28. Dollery, C.T.: Action of diazoxide. British Medical Journal 2:337(1962).CrossRefGoogle Scholar
  29. Ecknoyan, G.; Martinez-Maldonado, M.; Yium, J.J., and Suki, W.N.: Combined ascitic-fluid and furosemide infusion in the management of ascites. New England Journal of Medicine 282: 713–717 (1970).CrossRefGoogle Scholar
  30. Edelman, I.S.; Leibman, M.P., and Birkenfeld, L.W.: Interrelationships between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. Journal of Clinical Investigation 37: 1236–1256 (1958).PubMedCrossRefGoogle Scholar
  31. Editorial: Drug induced diabetes. Lancet 2: 328-329 (1965).Google Scholar
  32. Espiner, E.A.; Tucci, J.R.; Jagger, P.I.; Pank, G.L., and Laitier, D.P.: The effect of acute diuretic induced extra-cellular volume depletion on aldosterone secretion in normal man. Clinical Science 33: 125–134 (1967).PubMedGoogle Scholar
  33. Fairley, K.F. and Laver, M.: High dose intravenous frus-emide in renal failure. Supplement to Postgraduate Medical Journal (in press) (1970).Google Scholar
  34. Fine, S.L. and Levy, R.I.: Ethacrynic acid in acute pulmonary oedema. New England Journal of Medicine 273: 583(1965).PubMedCrossRefGoogle Scholar
  35. Finnerty, F.A., Jr.; Davidov, M., and Kakaviatos, N.: Hypertensive vascular disease: The long term effect of rapid reductions of arterial pressure with diazoxide. American Journal of Cardiology 19: 377–386 (1967).PubMedCrossRefGoogle Scholar
  36. Finnerty, F.A., Jr.: Hypertension — Recent Advances, p. 528 (Lea and Febiger, Philadelphia 1961).Google Scholar
  37. Fraser, R.; James, V.H.T.; Brown, J.J.; Isaac, P.; Lever, A.F., and Robertson, J.I.S.: Effect of angiotensin and of frusemide on plasma aldosterone, cortico-sterone, Cortisol and renin in man. Lancet 2: 989–991(1965).PubMedCrossRefGoogle Scholar
  38. Freeman, R.B.; Mäher, J.F.; Schreiner, G.E., and Mostofi, F.K.: Renal tubular necrosis due to nephrotoxicity of organic mercurial diuretics. Annals of Internal Medicine 57: 34–43 (1962).PubMedGoogle Scholar
  39. Freyburger, W.A.; Graham, B.E., and Zins, G.R.: Antidiuretic properties of hypotensive agents, with special reference to N,N-diallyl-melamine-N-oxide (U-20388). Pharmacologist 8: 182–192 (1966).Google Scholar
  40. Genest, J; De Champlain, J; Veyrat, R.; Boucher, R.; Tremblay, G.Y.; Strong, C.G.; Koiw, E., and Marc-Aurele, J.: Role of renin-angiotensin system in various physiological and pathological states. Hypertension (Proceedings of the Council for High Blood Pressure Research) 13: 97–106 (1965).Google Scholar
  41. Ginsberg, D.J.; Saad, A., and Gabuzda, G.J.: Metabolic studies with diuretic triamterene in patients with cirrhosis and ascites. New England Journal of Medicine 271: 1229–1235 (1964).PubMedCrossRefGoogle Scholar
  42. Gupta, K.K.; Misra, K.P.; Anand, I.S., and Caplash, V.K.: Furosemide in acute pulmonary oedema. Lancet 1: 1386–1387(1967).PubMedCrossRefGoogle Scholar
  43. Harrison, H.E. and Harrison, H.C.: Inhibitions of urine citrate excretion and the production of renal calcinosis in the rat by acetazolamide (Diamox) administration. Journal of Clinical Investigation 34: 1662–1670 (1955).PubMedCrossRefGoogle Scholar
  44. Harvey, R.B.: Vascular resistance changes produced by hyperosmotic solutions. American Journal of Physiology 199: 31–34 (1960).PubMedGoogle Scholar
  45. Heidland, A. and Wigand, M.E.: Influence of high doses of furosemide on hearing of uraemic patients. Klinische Wochenschrift 48: 1052–1056 (1970).PubMedCrossRefGoogle Scholar
  46. Hutcheon, D.E.: Effects of antikaliuretic diuretics on biochemical complications of thiazide therapy. Pharmacologist 9: 196–201 (1967).Google Scholar
  47. James, IM.; Nashat, S.; Sampson, D.; Williams, HS., and Garassini, M.: Effect of induced metabolic alkalosis in hepatic encephalopathy. Lancet 2: 1106–1108 (1969).PubMedCrossRefGoogle Scholar
  48. Jick, H.: The use of glucocorticoids for diuresis in patients with fluid retention not resulting from renal disease. Annals of New York Academy of Sciences 139: 512–519 (1966).CrossRefGoogle Scholar
  49. Kennedy, R.M. and Earley, L.E.: Profound hyponatraemia resulting from a thiazide-induced decrease in urinary diluting capacity in a patient with primary polydipsia. New England Journal of Medicine 282: 1185–1186 (1970).PubMedCrossRefGoogle Scholar
  50. Kincaid-Smith, P.: Drugs in renal disease. New Ethicals 10: (No 9), 249–264; New Ethicals and Medical Progress 6: (No 9), 259-273 (1969).Google Scholar
  51. Kincaid-Smith, P.; Saker, B.M., and Fairley, K.F.: Anticoagulants in ‘irreversible’ acute renal failure. Lancet 2:1360–1363(1968).PubMedCrossRefGoogle Scholar
  52. Kleeman, C.R.; Okun, R., and Heller, J.: The renal regulation of sodium and potassium in patients with chronic renal failure (CRF) and the effects of diuretics on the excretion of these ions. Annals of New York Academy of Science 139: 520–539 (1966).CrossRefGoogle Scholar
  53. Lal, S.; Murtagh, J.G.; Pollock, A.M.; Fletcher, E., and Binnion, P.F.: Acute haemodynamic effects of frus-emide in patients with normal and raised left atrial pressure. British Heart Journal 31: 711–717 (1969).PubMedCrossRefGoogle Scholar
  54. Lassen, N.A.: Treatment of severe acute barbiturate poisoning by forced diuresis and alkalinization of the urine. Lancet 2: 338–342 (1960).CrossRefGoogle Scholar
  55. Lawrence, J.R.; Johny, K. V.; Worthley, B. W., and O’Hallo-ran, M.W.: Effect of diuretics including amiloride on total body potassium. Acute and long term studies using a whole body monitor. In Proceedings of Fourth International Congress of Nephrology (Stockholm), in press (1970).Google Scholar
  56. Lebacq, E. and Marcq, M.: A study of the mechanism of ethacrynic acid induced hyperglycaemia. Revue française d’études cliniques et biologiques 12: 160–162 (1967).PubMedGoogle Scholar
  57. Ledingham, J.G.G.: Ethacrynic acid parenterally in the treatment and prevention of pulmonary oedema. Lancet 1: 952–954 (1964).PubMedCrossRefGoogle Scholar
  58. Ledingham, J.G.G. and Bayliss, R.I.S.: Ethacrynic acid: two years’ experience with a new diuretic. British Medical Journal 2:732–735 (1965).PubMedCrossRefGoogle Scholar
  59. Linton, A.L.; Luke, R.G.; Speirs, I., and Kennedy, A.C.: Forced diuresis and haemodialysis in severe barbiturate intoxication. Lancet 1: 1008–1010 (1964).PubMedCrossRefGoogle Scholar
  60. Lintrup, J.; Friss, T., and Nissen, N.I.: Comparative studies on the diuretic effect of chlorothiazide and spironolactone in cardiac and hepatic oedema. Acta Medica Scandinavica 174:425–439 (1963).PubMedCrossRefGoogle Scholar
  61. Lipman, I. and del Greco, F.: Observations on the effect of spironolactone in oedema associated with renal disease. American Journal of Medical Science 245: 413–420 (1963).CrossRefGoogle Scholar
  62. Luke, R.G.; Briggs, J.D.; Allison, M.E.M., and Kennedy, A.C.: Factors determining response to mannitol in acute renal failure. American Journal of Medical Sciences 259:168–181 (1970).CrossRefGoogle Scholar
  63. Lund-Johansen, P.: Haemodynamic changes in long term diuretic therapy of essential hypertension. Acta Medica Scandinavica 187: 509–518 (1970).PubMedCrossRefGoogle Scholar
  64. MacGillivray, I.: Bendroflumethiazide and pregnancy. American Journal of Obstetrics and Gynecology 91: 879–880 (1965).Google Scholar
  65. Magid, G.J.; Levitt, S.H.; Harper, H.A., and Forsham, P.H: Ammonia intoxication in a patient with cirrhosis treated with chlorothiazide. Journal of American Medical Association 168: 35–39 (1958).CrossRefGoogle Scholar
  66. Maher, J.F and Schreiner, G.F.: Studies of ethacrynic acid in patients with refractory oedema. Annals of Internal Medicine 62: 15–29(1965).PubMedGoogle Scholar
  67. Mann, J.B. and Gilmore, HR.: Reversal of mannitol-fast oliguriaby intravenous ethacrynic acid. Proceeding of American Society of Nephrology 1: 44–45 (1967).Google Scholar
  68. McDonald, HP, Jr. and Waterhouse, R.K.: Chronic renal failure from urological diseases: treatment by sodium balancing and low-protein diet of high biological value. Journal of Urology 103: 262–266 (1970).PubMedGoogle Scholar
  69. Menzies, D.N.: Controlled trial of chlorothiazide in treatment of early pre-eclampsia. British Medical Journal 1: 739–742(1964).PubMedCrossRefGoogle Scholar
  70. Merril, A.J.: Renal blood flow studies in heart failure. Journal of Clinical Investigation 25: 389–399 (1946).CrossRefGoogle Scholar
  71. Milne, M.D.; Scribner, B.H, and Crawford, M.A.: Non-ionic diffusion and the exclusion of weak acids and bases. American Journal of Medicine 24:700 (1958).CrossRefGoogle Scholar
  72. Moser, M.: Treatment of ‘hypertensive encephalopathy’ (accelerated hypertension). Part II. American Heart Journal 77: 704–706 (1969).PubMedCrossRefGoogle Scholar
  73. Mroczek, W.J.; Davidov, M.; Gavrilovich, L., and Finnerty, FA.: The value of aggressive therapy in the hypertensive patient with azotaemia. Circulation 40: 893–904 (1969).CrossRefGoogle Scholar
  74. Muth, R.: Diuretic properties of furosemide in renal disease. Annals of Internal Medicine 69: 249–261 (1968).PubMedGoogle Scholar
  75. Myerson, R.M.: The diuretic effect of polythiazide in cirrhosis of the liver. Current Therapeutic Research 3: 431–437 (1961).PubMedGoogle Scholar
  76. Nassim, J.R. and Higgins, B.A.: Control of hypercalciuria. British Medical Journal 1: 675–681 (1965).PubMedCrossRefGoogle Scholar
  77. Newell, A.C.: Ethacrynic acid in treatment of ambulatory patients. Medical Journal of Australia 1: 320–322 (1970).Google Scholar
  78. Nicotero, J.A.; Scheib, ET.; Martinez, R.; Rodnan, G.P., and Shapiro, A.P.: Prevention of hyperuricaemia by allopurinol in hypertensive patients treated with chlorothiazide. New England Journal of Medicine 252: 133–135 (1970).CrossRefGoogle Scholar
  79. Orloff, J.; Walser, M.; Kennedy, T.J., and Bartter, F.C.: Hyponatraemia. Circulation 19: 284–299 (1959).PubMedCrossRefGoogle Scholar
  80. Peltola, P.: Frusemide (Lasix) as a diuretic. Acta Medica Scandinavica 177: 777–782 (1965).PubMedCrossRefGoogle Scholar
  81. Pillay, V.K.G.; Schwartz, F.D.; Aimi, K, and Kark, R.M.: Transient and permanent deafness following treatment with ethacrynic acid in renal failure. Lancet 1: 77–79(1969).PubMedCrossRefGoogle Scholar
  82. Read, A.E.; Haslam, R.M., and Laidlaw, J.: Chlorothiazide in control of ascites in hepatic cirrhosis. British Medical Journal 1: 963–966 (1958).PubMedCrossRefGoogle Scholar
  83. Rivera, A.; Flores, A., and Suarez, M.A.: Sodium retention following diuretic therapy. Clinical Pharmacology and Therapeutics 2:286–295 (1964).Google Scholar
  84. Robson, A.O.; Kerr, D.N.S.; Ashcroft, R., and Teasdale, G.: The diuretic response to frusemide. Lancet 2: 1085–1089(1964).PubMedCrossRefGoogle Scholar
  85. Robson, J.S. and Lambie, A.T.: The effect of chlorothiazide in diabetes insipidus with particular reference to the osmolality of the serum. Metabolism 2: 1041–1053(1962).Google Scholar
  86. Rosenberg, B.; Dobkin, G., and Rubin, R.: The intravenous use of ethacrynic acid in the management of acute pulmonary oedema. American Heart Journal 70: 333–336(1965).PubMedCrossRefGoogle Scholar
  87. Schneider, W.J. and Becker, E.L.: Acute transient hearing loss after ethacrynic acid therapy. Archives of Internal Medicine 117: 715–717(1966).PubMedCrossRefGoogle Scholar
  88. Schreiner, B.F., Jr.; Murphy, G.W., and Yu, P.N.: Pulmonary blood volume in congestive heart failure. Circulation 34: 249–259(1966).CrossRefGoogle Scholar
  89. Schreiner, G.E. and Bloomer, H.A.: Effect of chlorothiazide on the oedema of cirrhosis, nephrosis, congestive heart failure, and chronic renal insufficiency. New England Journal of Medicine 257: 1016–1022 (1957).PubMedCrossRefGoogle Scholar
  90. Schroder, G.; Sannerstedt, R., and Werko, L.: Clinical experiments with ethacrynic acid, a new non-thiazide saluretic agent (MK-595). Acta Medica Scandinavica 775:781–786(1964).Google Scholar
  91. Schwartz, G.H.; David, D.S.; Riggio, R.R.; Stenzel, K.H., and Rubin, A.L.: Ototoxicity induced by furos-emide. New England Journal of Medicine 282: 1413–1414(1970).PubMedCrossRefGoogle Scholar
  92. Seller, R.H; Swartz, C.D.; Ramirez-Muxo, O.; Brest, A.H., and Moyer, J.H.: Aldosterone antagonists in diuretic therapy. Archives of Internal Medicine 113: 350–355 (1964).PubMedCrossRefGoogle Scholar
  93. Shapiro, A.P.; Benedek, T.G., and Small, J.L.: Effect of thiazides on carbohydrate metabolism in patients with hypertension. New England Journal of Medicine 265: 1028–1033(1960).CrossRefGoogle Scholar
  94. Sherlock, S.; Senewiratne, B.; Scott, A., and Walker, J.G.: Complications of diuretic therapy in hepatic cirrhosis. Lancet 1:1049–1052(1966).PubMedCrossRefGoogle Scholar
  95. Slatopolsky, E; Elkan, I.O.; Weerts, C., and Bricker, N.S.: Studies on the characteristic of the control system governing sodium excretion in uremic man. Journal of Clinical Investigation 47: 521–530 (1968).PubMedCrossRefGoogle Scholar
  96. Slone, D.; Jick, H; Lewis, G.P.; Shapiro, S., and Miettinen, O.S.: Intravenously given ethacrynic acid and gastro-intestinal bleeding. Journal of American Medical Association 209: 1668–1671(1969).CrossRefGoogle Scholar
  97. Spark, R.F. and Melby, J.C.: Aldosterone in hypertension. The spironolactone response test. Annals of Internal Medicine 69:685–691 (1968).PubMedGoogle Scholar
  98. Spiekerman, R.E.; Berge, K.G.; Thurber, D.L.; Gedge, S. W., and McGuckin, W.F.: Potassium sparing effects of triamterene in the treatment of hypertension. Circulation 34: 524–531 (1966).PubMedCrossRefGoogle Scholar
  99. Stahl, W.M.: Effect of mannitol on the kidney. Changes in intrarenal haemodynamics. New England Journal of Medicine 272: 381–386(1965).CrossRefGoogle Scholar
  100. Stason, W.B.; Cannon, P.J.; Heinemann, H.O., and Laragh, J.H.: Furosemide, a clinical evaluation of its diuretic action. Circulation 34: 910–920 (1966).PubMedCrossRefGoogle Scholar
  101. Steigmann, F.; Oz, R., and Dubin, A.: A new diuretic for intractable ascites (Abstract). Federation Proceedings 24: 258 (1965).Google Scholar
  102. Stokes, W. and Nunn, L.C.A.: A new effective diuretic-Lasix. British Medical Journal 2: 910–914 (1964).PubMedCrossRefGoogle Scholar
  103. Suki, W.N.; Hall, A.R.; Rector, F.C, Jr., and Seidin, D.: Mechanism of the effect of thiazide diuretics on calcium and uric acid. Clinical Research 15: 78 (1967).Google Scholar
  104. Thurau, K.: Renal haemodynamics. American Journal of Medicine 36: 698–719 (1964).PubMedCrossRefGoogle Scholar
  105. Tobian, L.: Why do thiazide diuretics lower blood pressure in essential hypertension. Annual Review of Pharmacology 7: 399–408 (1967).PubMedCrossRefGoogle Scholar
  106. Toivonen, S. and Musíala, O.: Diabetogenic action of frusemide. British Medical Journal 1: 920–921 (1966).PubMedCrossRefGoogle Scholar
  107. Vesin, P.; Rueff, B.; Traverso, H.; Birsch-Marie, H. et Cattan, R.: L’insuffisance rénale fonctionnelle du cir-rhotique ascitique. Etude critique du rôle des diurétiques. Bulletins et mémoires de la Société médicale des hôpitaux de Paris 113: 778–795 (1962).Google Scholar
  108. Warren, K.S.; Iber, F.L.; Dolle, W., and Sherlock, S.: The effect of alterations in blood pH on the distribution of ammonia from blood to cerebrospinal fluid in patients in hepatic coma. Journal of Laboratory and Clinical Medicine 56: 687–694 (1960).PubMedGoogle Scholar
  109. Wilson, I.M. and Freis, E.D.: Relationship between plasma and extracellular fluid volume depletion and the antihypertensive effect of chlorothiazide. Circulation 20: 1028–1036 (1959).PubMedCrossRefGoogle Scholar
  110. Winer, B.M.: The antihypertensive mechanism of salt depletion induced by hydrochlorothiazide. Circulation 24: 788–796 (1961).PubMedCrossRefGoogle Scholar
  111. Winer, B.M.; Lubbe, W.F., and Colton, T.: Antihypertensive actions of diuretics. Journal of American Medical Association 204: 117–121 (1968).CrossRefGoogle Scholar
  112. Wolff, F.W.; Langdon, R.G.; Ruebner, B.; Hollander, C., and Skoglund, R.D.: A new form of experimental diabetes. Diabetes 12: 335–338 (1963).PubMedGoogle Scholar
  113. Wolff, H.P.; Koczorek, K.R., and Buchborn, E.: Hyperaldo-steronism in heart disease. Lancet 2: 63–66 (1957).CrossRefGoogle Scholar

Copyright information

© Adis International Limited 1971

Authors and Affiliations

  • John L. Anderton
    • 1
  • Priscilla Kincaid-Smith
    • 2
  1. 1.Department of TherapeuticsRoyal InfirmaryEdinburghScotland
  2. 2.Medical Renal Unit, Royal Melbourne Hospital and Department of MedicineUniversity of MelbourneVictoriaAustralia

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