Primary hyperparathyroidism and thiazide diuretics postgraduate. Diuretics and disorders of calcium homeostasis seminars in. Thiazide diuretics and calcium metabolism sciencedirect. Their effects on calcium metabolism appear to be less well appreciated. Clinically, these changes include a decreased excretion of calcium, and in some instances, this results in a corresponding increase in bone mineral.
Calcium metabolism and hypertension kidney international. Thiazidelnduced rise in serum calcium and magnesium in. Calcium excretion is increased by loop diuretics and diminished by thiazide type diuretics and amiloride. Thiazide diuretics and calcium what does the doctor say. Benzothiadiazine nucleus thiazide diuretics pharmacological actions on kidney and electrolytes. Thiazides have several metabolic effects contributing to higher serum. A detailed examination follows of the sites and modes of action of furosemide and thiazide diuretics on renal calcium. Thiazide diuretics cause changes in calcium metabolism. Subacute effects of thiazide administration on renal. A substantial body of data bearing on this subject, some of which. Marked hypercal cemia may be evidence of hidden hyperparathy roidism. It is now frequently recognized that thiazide diuretics can appreciably influence calcium metabolism. Are thiazides contraindicated in patients with type 2. Diuretics and calcium metabolism american journal of kidney.
Effect of thiazide on urine and serum calcium levels. Hypercalcemic response to hydrochlorothiazide in uremia. Pdf thiazide increases serum calcium in anuric patients. Cell metabolism article potassium modulates electrolyte balance and blood pressure through effects on distal cell voltage and chloride andrew s. Thiazide diuretics diminish hydroxyproline excretion by about 22%, and they do not affect 3. Hypocitraturia in the setting of thiazide induced hypokalemia may counter the bene. Portland, oregon a 28yearold black male was referred to the hypertension clinic. Effects of diuretics on calcium metabolism springerlink. These findings, together with additional data in the.
In addition to their known effects on sodium metabolism diuretic agents also. The serum calcium test is used to evaluate parathyroid function and calcium metabolism by directly measuring the total amount of calcium in the blood. Thiazide therapy may be a good alternative to surgery for 2 particular subsets of patients 1 with a baseline level as follows. Thiazide diuretics reduce urinary excretion of calcium by about 40% in patients with intact parathyroid glands normal parathyroid function or primary hyperparathyroidism. To elucidate the renal effects of thiazides as a function of sodium intake, 8 healthy volunteers without renal disease were studied at baseline and 1 day as well as 4 days after the administration of. The effects of thiazide diuretics on bone mineral metabolism. Thiazide diuretics and calcium metabolism by stewart middler, charles y.
A detailed examination follows of the sites and modes of action of furosemide and thiazide diuretics on renal calcium handling and overall calcium metabolism. Like acetazolamide, these drugs are secreted into the tubular fluid and block the electro neutral sodium and. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Calcium metabolism disorders renal and urology news. Thiazide diuretics, potassium, and the development of. Other uses include diabetes insipidus, renal tubular acidosis, and to.
Pdf we evaluated the effect of hydrochlorothiazide in a sample of anuric patients on hemodialysis and found an increase in serum calcium, which. Serum calcium concentrations are increased independently of pth levels 8. Botheffects can beabolished with sodium replacement brickman et al. Thiazides may decrease urinary calcium, and in primary hyperparathyroidism such drugs may aggravate hypercalcemia, presumably because of reduced renal excretion of calcium. Calcium metabolism and hypertension principal discussant. The thiazide effect on increasing bone mass and reducing bone loss has been reported for more than 20 years 337, 347353. Pdf thiazide treatment in primary hyperparathyroidism. Thiazides should be discontinued before carrying out tests for parathyroid function.
Thiazide diuretics are primary used to treat the hypertension high blood pressure and edema swelling caused by water overload as well as certain conditions related to unbalanced. The renal excretion of calcium is con sistently reduced by thiazide diuretics higgins. Patients were accepted as having thiazide associated hypercalcemia if they met the following criteria. Incidence and clinical spectrum of thiazideassociated. We studied the effects of different doses of a td and ld on electrolytes, calcitropic hormones and. Pharmacology and clinical use of diuretics katie herndon, pharm. Diuretics and calcium metabolism american journal of. Hypercalcemia associated with thiazide diuretic use is a well recognized clinical entity. In addition to their known effects on sodium metabolism diuretic agents also exert profound effects on calcium metabolism. It may cause not only an increased risk of cardiac arrhythmias but also impaired glucose tolerance and abnormal lipid metabolism, while replacement of potassium has been shown to eliminate the risk of. Thiazide diuretics and calcium metabolism metabolism clinical. Despite equivalent sodium losses, thiazide diuretics do not lower calcium excretion in patients with hypoparathyroidism. Current use of thiazide diuretics was associated with a 10% 95% ci, 712% reduced risk of any fracture and a 17% 95% ci, 1123% reduced risk of forearm fracture 346. Thiazides and thiazidetype drugs inhibit sodium chloride nacl transport in the distal convoluted tubule of the nephron, leading to increased nacl excretion.
Oral calcium supplementation should be initiated at the same time as the calcium infusion. A decrease in urinary calcium has been related to the oral administration of chlorothiazide and. The nondiuretic thiazide diazoxide is used treat hypoglycemia, not by inducing hypokalemia, but because it hyperpolarizes the islet cell membrane in the pancreas, inhibiting calcium influx and, thus, the. Calcium reabsorption and urinary calcium excretion can be affected by the administration of diuretics. Changes in serum and urinary calcium during treatment with. The reduction in urinary calcium loss resulting from treatment with thiazide diuretics is due primarily to changes in kidney function and may also be due, in part, to changes in vitamin d metabolism. The study of mineral metabolism in bone is difficult because of the slow turnover rate of bone. The rise in serum calcium could be due to thiazideinduced release of calcium from bone into extracellular fluid, particularly in states where bone resorption may be augmented. Robert neer, in his succinct and rather complete summary on the effects of thiazide diuretics on calcium metabolism n engl j med 286. Background thiazide diuretics tds reduce whereas loop diuretics lds increase urinary calcium. Primary hyperparathyroidism and thiazide diuretics davies.
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