title: Reversal of the suppressed potassium excretion during treatment with combinations of antikaliuretic drugs (spironolactone, canrenone, triamterene, amiloride) in patients with liver cirrhosis.
abstract: "Refractory" ascites was drained off by combinations of antialdosterone (spironolactone, canrenone) and pseudoantialdosterone (triamterene, amiloride) drugs inducing as high sodium excretion as 100 mEq per day in two patients with liver cirrhosis kept on a 9 mEq Na diet. Potentiation of the natriuretic effects of the two types of antikaliuretic drugs occurred by real synergism rather than addition. Although natriuretic acitivity showed a typical dose-related pattern, potassium excretion was unpredictable. Significant increase in potassium excretion (reversal of the suppression) occurred when 300 mg triamterene was combined with 200 mg canrenone in one of the two patients and when the dose of spironolactone or canrenone was increased from 200 mg to 600 mg within the combinations with 300 mg triamterene or 20 mg amiloride in the other. Parallel increase in sodium and potassium excretions might be caused by a proximal tubular effect or by inhibition of potassium reabsorption along with sodium in Henle's loop. The vasopressin (DDAVP) refractory distorsion of the relationship between osmolal clearance and free water reabsorpton (induced by pseudo-antialdosterone agents and potentiated by antialdosterone drugs) observed in all the 6 cases of the present patient material favoured the "loop hypothesis".
mesh_terms: D000584:Amiloride / Q000627:therapeutic use; D001201:Ascites / Q000188:drug therapy; D002192:Canrenone / Q000627:therapeutic use; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000652:urine; D009318:Natriuresis / Q000187:drug effects; D011188:Potassium / Q000652:urine*; D013148:Spironolactone / Q000627:therapeutic use; D014223:Triamterene / Q000627:therapeutic use
chemical_list: D004232:Diuretics; D013148:Spironolactone; D002192:Canrenone; D000584:Amiloride; D011188:Potassium; D014223:Triamterene