Several measures may help to reduce the frequency and severity of diuretic-associated metabolic adverse effects. The lowest possible dose of the diuretic that will work should be used. This is true not only for diuretics, but for all other antihypertensive drugs. Moderate sodium restriction i.e., a diet containing 4-6 g of salt per day, should be employed. This is about 68-103 mEq/L sodium per day. Patients can use salt substitutes if they really feel it is necessary and if there are no contraindications. The added potassium may be beneficial. Some sodium restriction is not too much to ask of patients. It increases the efficiency of the diuretic and decreases potassium loss. Patients should decrease their fat and cholesterol intake. This is a prophylactic measure, in response to one of the risk factors for coronary heart disease, but also it has been demonstrated in one study to blunt or abolish the rise in total cholesterol associated with diuretic use. We are in complete agreement that reflex potassium supplementation is likely to be unwarranted. Patients who should be supplemented are those taking digitals and those who have edema. In addition, we believe, on the basis of these preliminary trials, that those patients who have clinically evident organic heart disease as determined by history, physical examination, electrocardiograms, and chest X-ray films should have their serum potassium levels normalized.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine