Which diuretic is most associated with hyperkalemia?

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Multiple Choice

Which diuretic is most associated with hyperkalemia?

Spironolactone is the diuretic most associated with hyperkalemia. It acts as a potassium-sparing diuretic by blocking the aldosterone receptor in the collecting ducts. This reduces the synthesis of epithelial sodium channels and the Na+/K+ ATPase, so less sodium is reabsorbed and less potassium is secreted into the urine. The net effect is potassium retention in the blood, which can lead to hyperkalemia, especially with kidney impairment or when combined with other agents that raise potassium. In contrast, loop diuretics like furosemide and thiazide diuretics increase sodium delivery to the distal nephron, promoting potassium excretion and usually causing hypokalemia. Acetazolamide can cause metabolic acidosis and tends to cause potassium losses rather than retention.

Spironolactone is the diuretic most associated with hyperkalemia. It acts as a potassium-sparing diuretic by blocking the aldosterone receptor in the collecting ducts. This reduces the synthesis of epithelial sodium channels and the Na+/K+ ATPase, so less sodium is reabsorbed and less potassium is secreted into the urine. The net effect is potassium retention in the blood, which can lead to hyperkalemia, especially with kidney impairment or when combined with other agents that raise potassium.

In contrast, loop diuretics like furosemide and thiazide diuretics increase sodium delivery to the distal nephron, promoting potassium excretion and usually causing hypokalemia. Acetazolamide can cause metabolic acidosis and tends to cause potassium losses rather than retention.

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