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Furosemide
80%
8/10
Metoprolol
0%
0/10
Polyethylene glycol
10%
1/10
Spironolactone
Amiloride
Select Answer to see Preferred Response
An athlete trying to lose weight in the setting of low serum Na+ and K+ with high urine Na+ and K+ is likely abusing loop diuretics such as furosemide. The mainstay of diuretics is through use as antihypertensive agents and agents that limit fluid retention in patients suffering from congestive heart failure, cirrhosis, and nephropathies. They all promote excretion of water through different mechanisms. Loop diuretics promote excretion of both Na+ and K+ along with Cl- along the loop of Henle, while thiazide diuretics cause excretion of Na+ and Cl- in the distal convoluted tubule. Diuretics such as spironolactone and amiloride are K+ sparing diuretics, which act on the collecting duct. Skolnik et al. discuss antihypertensive therapies. They report that in long-term trials, diuretics have been shown to reduce the incidence of stroke, congestive heart failure, and coronary artery disease. Still, many of these medications are associated with side effects. For example, thiazide diuretics cause increases in LDL levels along with hyperglycemia and uric acid retention that may lead to gout flares, especially at high doses. These side effects are much less prevalent at low doses. Cadwallader et al. report on abuse of diuretics as performance-enhancing agents. They report that diuretics are abused by athletes to excrete water for (1) rapid weight loss and even to (2) to mask the presence of other banned substances. Because of this, diuretics have been included on The World Anti-Doping Agency's (WADA) list of prohibited substances. They report that in 2008, of all samples tested by WADA, almost 8% of them tested positive for diuretics (with furosemide and hydrochlorothiazide as the most common diuretics). Incorrect Answers: Answer 2: Metoprolol abuse would result in hypotension, with bradycardia and possibly heart block. It would not result in polyuria with increased Na+ and K+ excretion in the urine. Answer 3: Polyethylene glycol would result in more frequent bowel movements, not polyuria. Answers 4 and 5: Spironolactone and amiloride are both K+ sparing diuretics and would result in a low K+ concentration in urine.
5.0
(4)
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