Diuretics, Loop Diuretics

Loop Diuretics

  • Bumetanide
  • Ethacrynic Acid
    (no brand names listed)
  • Furosemide
  • Torsemide


Osteoporosis (bone loss) is the primary disease associated with long-term calcium deficiency; it may be associated with bone pain and spinal deformity. Depleted levels can also cause muscle cramps, irregular heartbeat, and depression.


Magnesium deficiency affects calcium and vitamin D levels in the body and may be associated with muscle cramps, heart irregularities, high blood pressure, diabetes, and osteoporosis (bone loss).


Although phosphorus deficiency is rare, long-term low levels are associated with muscle weakness, bone pain, mental confusion, loss of appetite, anemia, increased susceptibility to infection, respiratory difficulties, seizures, and even death.


Symptoms of deficiency include loss of appetite, nausea, drowsiness, feelings of apprehension, excessive thirst, irrational behavior, fatigue, muscle pain and weakness (usually of the lower limbs); severe cases may lead to irregular heartbeat.

Vitamin B1 (Thiamine)

Symptoms of depleted levels of thiamine include weakness, fatigue, anorexia, constipation, memory loss, confusion, and depression. Deficiency may lead to beriberi, a condition characterized by inflammation of nerves, heart irregularities, and fluid retention.

Vitamin B6 (Pyridoxine)

Symptoms of vitamin B6 deficiency may include weakness, nervousness, insomnia, mental confusion, irritability, and anemia. Long-term low levels of this nutrient may also increase the risk of heart disease as well as colon and prostate cancers.

Vitamin C (Ascorbic Acid)

Vitamin C deficiency may include bruising, fever, anemia, emotional changes, swollen and bleeding gums, fatigue, lethargy, jaundice (yellowing of the skin and eyes), increased susceptibility to infections, slow wound healing, and swelling of the lower limbs. Severe deficiency leads to scurvy, a disorder that affects muscles and bones and is potentially fatal. However, scurvy is rare these days because of the wide availability of vitamin C from dietary sources.

Supporting Research 

Abrams J. Intramuscular bumetanide and furosemide in congestive heart failure. J Clin Pharmacol. 1981;21:673-679.

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Brady JA, Rock CL, Horneffer MR. Thiamin status, diuretic medications, and the management of congestive heart failure. J Am Diet Assoc. 1995;95(5):541-544.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr 1999;69:1086-1087.

Carriere S, Dandavino R. Bumetanide, a new loop diuretic. Clin Pharm Ther. 1976;20:424-438.

Cashman K, Flynn A. Optimal nutrition: calcium, magnesium and phosphorus. Proc Nutr Soc. 1999;58:477-487.

Covington T, ed. Nonprescription Drug Therapy Guiding Patient Self-Care. St Louis, MO: Facts and Comparisons; 1999:467-545.

Davies DL, Lant AF, Millard NR, Smith AJ, Ward JW, Wilson GM. Renal action, therapeutic use, and pharmacokinetics of the diuretic bumetanide. Clin Pharmacol Ther. 1974;15:141-155.

Fujita T, Delea CS, Bartter FC. The effects of oral furosemide on the response of urinary excretion of cyclic adenosine monophosphate and phosphate to parathyroid extract in normal subjects. Nephron. 1985;41(4):333-336.

Hines Burnham T, et al, eds. Drug Facts and Comparisons. St. Louis, Mo:Facts and Comparisons; 2000:624-626.

Leary WP, Reyes AJ, Wynne RD, van der Byl K. Renal excretory actions of furosemide, of hydrochlorothiazide and of the vasodilator flosequinan in healthy subjects. J Int Med Res. 1990;18:120-141.

Mydlik M, Derzslova K, Zemberova E, Rajnic A. [The effect of furosemide on urinary excretion of oxalic acid, vitamin C and vitamin B6 in chronic renal failure.] Vnitr Lek. 1998;44(3):127-131.

National Research Council. Recommended Dietary Allowances. 10th ed. Washington, DC: National Academy Press; 1989.

Ogawa K, Hatano T, Yammoto M, Matsui N. Influence of acute diuresis on calcium balance - a comparative study of furosemide and azosemide. Int J Clin Pharmacol, Ther, Toxicol. 1984;22(8):401-405.

Potts JT. Diseases of the parathyroid gland and other hyper- and hypocalcemic disorders. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill Companies Health Professional Division; 1998:2241.

Quamme GA. Renal magnesium handling: new insights in understanding old problems. Kidney Int. 1997;52(5):1180-1195.

Rastogi S, Bayliss JM, Nascimento L, Arruda JA. Hyperkalemic renal tubular acidosis: effect of furosemide in humans and in rats. Kidney Int. 1985;28(5):801-817.

Rieck J, Halkin H, Almog S, et al. Urinary loss of thiamine is increased by low doses of furosemide in healthy volunteers. J Lab Clin Med. 1999;134(3):238-243.

Ryan MP. Magnesium and potassium-sparing diuretics. Magnesium. 1986;5(5-6):282-292.

Seligmann H, Halkin H, Rauchfleisch S, et al. Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy: a pilot study. Am J Med. 1991;91(2):151-155.

Warshaw BL, Anand SK, Kerian A, Lieberman E. The effect of chronic furosemide administration on urinary calcium excretion and calcium balance in growing rats. Pediatr Res. 1980;14(10):1118-1121.

Wilson JD. Vitamin deficiency and excess. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill Companies Health Professional Division; 1998:483-485.

Review Date: October 2000
Reviewed By: All depletions monographs have been reviewed by a team of experts including Derrick M. DeSilva, Jr., MD, Raritan Bay Medical Center, Perth Amboy, NJ; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor, A.D.A.M., Inc., Boston, MA; John Hinze, PharmD, NMD, Woodbine, IA; Ruth Marlin, MD, Medical Director and Director of Medical Education, Preventive Medicine Research Institute, Sausalito, CA; Brian T Sanderoff, PD, BS in Pharmacy, Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA, President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

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