Skip to main content
Log in

Effect of chronic oral furosemide administration on the 24-hour cycle of lithium clearance and electrolyte excretion in humans

  • Originals
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

The effect of chronic furosemide treatment on the circadian cycle of lithium clearance (CLLi) and electrolyte excretion has been examined in 8 young, male volunteers, by performing two 24 h clearance experiments, before and after one week of treatment with furosemide 80 mg once daily.

After 8 days on furosemide there was a significant decrease in creatinine clearance (−21%), plasma Na (−8.4 mM) and plasma K (−0.58 mM). At that time, however, there were no changes in 24 h-values of CLLi or Na excretion, although the magnitude of the circadian variation in CLLi and other renal parameters was increased. Both CLLi and CLNa were increased in the first 3 h following furosemide administration and thereafter they fell below the control level in the remaining hours of the experiment.

From the absolute and fractional changes in CLLi it is suggested that compensatory Na conservation in response to chronic furosemide treatment occurs between doses, and that it involves decreased output from the proximal tubules combined with increased fractional Na reabsorption in the distal nephron.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

CL:

renal clearance

Cu :

urinary concentration

Cp :

plasma concentration

Vur :

urinary volume

fe :

fractional excretion

GFR:

glomerular filtration rate

CR:

creatinine

References

  1. Thomsen K (1984) Lithium clearance: A new method for determining proximal and distal tubular reabsorption of sodium and water. Nephron 37: 217–223

    Google Scholar 

  2. Thomsen K, Schou M (1968) Renal lithium excretion in man. Am J Physiol. 215: 823–827

    Google Scholar 

  3. Seely JF, Dirks JH (1977) Site of action of diuretic drugs. Kidney Int 11: 1–8

    Google Scholar 

  4. Steele TH, Dudgeon KL, Larmore CK (1976) Pharmacological characterization of lithium reabsorption in the rat. J Pharmacol Exp Ther 196: 188–193

    Google Scholar 

  5. Thomsen K, Leyssac PP (1986) Acute effects of various diuretics on lithium clearance. Studies in rats on medium and low sodium diet. Renal Physiol 9: 1–8

    Google Scholar 

  6. Petersen V, Hvidt S, Thomsen K, Schou M (1974) Effect of prolonged thiazide treatment on renal lithium clearance. Br J Med 3: 143–145

    Google Scholar 

  7. Thomsen K, Schou M (1973) The effect of prolonged administration of hydrochlorothiazide on the renal lithium clearance and the urine flow of ordinary rats and rats with diabetes insipidus. Pharmacopsychiatry 6: 264–269

    Google Scholar 

  8. Weinman EJ, Eknoyan G (1975) Chronic effect of chlorothiazide on reabsorption by the proximal tubule of the rat. Clin Sci Molec Med 49: 107–113

    Google Scholar 

  9. Walter SJ, Shirley DG (1986) The effect of chronic hydrochlorothiazide administration on renal function in the rat. Clin Sci 70: 379–387

    Google Scholar 

  10. Shirley DG, Walter SJ, Thomsen K (1983) A comparison of micropuncture and lithium clearance methods in the assessment of renal tubular function in rats with diabetes insipidus. Pflügers Arch 399: 266–270

    Google Scholar 

  11. MacNeil S, Hanson-Nortey E, Paschalis C, Eastwood PR, Jenner FA (1975) Diuretics during lithium therapy. Lancet I: 1295–1296

    Google Scholar 

  12. Lutz EG (1975) Lithium toxicity precipitated by diuretics. J Med Soc New Jersey 72: 439–440

    Google Scholar 

  13. Kerry RJ, Ludlow JM, Owen G (1980) Diuretics are dangerous with lithium. Br Med J 281: 371

    Google Scholar 

  14. Steele TH, Manuel MA, Newton M, Boner G (1975) Renal lithium reabsorption in man: physiologic and pharmacologic determinants. Am J Med Sci 269: 349–363

    Google Scholar 

  15. Rombola G, Colussi G, de Ferrari ME, Surian M, Malberti F, Minetti L (1987) Clinical evaluation of proximal tubule Na/fluid reabsorption: Lithium clearance vs. “Volume or chloride factors” during maximal water diuresis and furosemide administration. In: Andreucci VE, Canton AD, eds. Diuretics: Basic, Pharmacological and Clinical Aspects. Boston: Martinus Nijhoff Publishing, pp 539–541

    Google Scholar 

  16. Sjöström P, Odlind B, Beermann B (1987) Is lithium an ideal marker of proximal tubular sodium reabsorption? In: Puschett JB, Greenberg A, eds. Diuretics II: Chemistry, Pharmacology and Clinical Applications. Elsevier, New York, pp 215–217

    Google Scholar 

  17. Dorhout Mees EJ, Boer WH, Koomans HA (1987) Estimation of free water back diffusion during water diuresis in man using lithium clearance and furosemide effect: some unresolved questions. In: Andreucci VE, Canton AD, eds. Diuretics: Basic, Pharmacological and Clinical aspects. Martinus Nijhoff, Boston, pp 79–81

    Google Scholar 

  18. Atherton JC, Green R, Hughes S, McFall V, Sharples JA, Solomon LR, Wilson L (1987) Lithium clearance in man: effects of dietary salt intake, acute changes in extracellular fluid volume, amiloride and frusemide. Clin Sci 73: 645–651

    Google Scholar 

  19. Christensen S, Steiness E, Christensen H (1986) Tubular sites of furosemide natriuresis in volume-replaced and volume-depleted conscious rats. J Pharmacol Exp Ther 239: 211–218

    Google Scholar 

  20. Christensen S, Petersen JS, Steiness E, Andreasen F (1987) Dose dependence of proximal and distal tubular effects of furosemide in conscious rats. J Pharmacol Exp Ther 241: 987–993

    Google Scholar 

  21. Christensen S, Petersen JS (1988) Effects of furosemide on renal haemodynamics and proximal tubular sodium reabsorption in conscious rats. J Pharmacol 95: 353–360

    Google Scholar 

  22. Kirchner KA (1987) Lithium as a marker for proximal tubular delivery during low salt intake and diuretic infusion. Am J Physiol 253: F188-F196

    Google Scholar 

  23. Christensen S, Shalmi M, Petersen JS (1988) Lithium clearance as an indicator of proximal tubular sodium handling during furosemide diuresis. J Pharmacol Exp Ther 248: 753–757

    Google Scholar 

  24. Christensen S (1990) Furosemide effect during volume expansion: Evidence against lithium transport in Henle's loop. Kidney Int 37

  25. Parfrey PS, Ikeman R, Anglin D, Cole C (1983) Severe lithium intoxication treated by forced diuresis. Can Med Assoc J 129: 979–980

    Google Scholar 

  26. Steele TH (1977) Treatment of lithium intoxication with diuretics. In: Brown SS (ed) Clinical Chemistry and Chemical Toxicology of Metals. Elsevier, Amsterdam, pp 289–292

    Google Scholar 

  27. Bonsnes RW, Taussky HH (1945) On the colorimetric determination of creatinine by the Jaffe reaction. J Biol Chem 158: 581–591

    Google Scholar 

  28. Kahn T, von Albertini B, Goldstein M, Levitt MF, Bosch JP (1980) Effect of increased NaCl or KCl intake on response to chronic furosemide administration. Am J Physiol 238: F509-F514

    Google Scholar 

  29. Wilcox CS, Mitch WE, Kelly RA, Skorecki K, Meyer TW, Friedman PA, Souney PF (1983) Response of the kidney to furosemide. I. Effects of salt intake and renal compensation. J Lab Clin Med 102: 450–458

    Google Scholar 

  30. Jefferson JW, Kalin NH (1979) Serum lithium levels and longterm diuretic use. JAMA 241: 1134–1136

    Google Scholar 

  31. Saffer D, Coppen A (1983) Frusemide: A safe diuretic during lithium therapy. J Affective Disord 5: 282–292

    Google Scholar 

  32. Brater DC, Chennavasin P, Day B, Burdette A, Anderson S (1983) Bumetanide and furosemide. Clin Pharmacol Ther 34: 207–213

    Google Scholar 

  33. Sjöström P (1988) Mechanisms of reduced effects of Loop diuretics in healthy volunteers and in patients with renal disease. Scand J Urol Nephrol 22 (Suppl 111): 1–66

    Google Scholar 

  34. Lauritzen BJ, Mellerup ET, Plenge P, Rasmussen S, Vestergaard P, Schou M (1981) Serum lithium concentrations around the clock with different treatment regimens and the diurnal variation of the renal lithium clearance. Acta Psychiatr Scand 64: 314–319

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shalmi, M., Rasmusen, H., Amtorp, O. et al. Effect of chronic oral furosemide administration on the 24-hour cycle of lithium clearance and electrolyte excretion in humans. Eur J Clin Pharmacol 38, 275–280 (1990). https://doi.org/10.1007/BF00315030

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00315030

Key words

Navigation