Which class of diuretics can cause metabolic alkalosis?

Loop diuretics, such as furosemide, can indeed cause metabolic alkalosis, primarily due to their action on electrolyte balance. When loop diuretics are administered, they inhibit the sodium-potassium-chloride co-transporter in the ascending loop of Henle within the nephron. This inhibition leads to increased sodium and chloride excretion, which disrupts normal electrolyte balance and can result in increased hydrogen ion secretion in the kidneys.

As sodium reabsorption is impaired, the body attempts to compensate for the loss of sodium by increasing the retention of bicarbonate, which can lead to metabolic alkalosis. Additionally, the gradual loss of volume and the subsequent increase in proximal tubular reabsorption of bicarbonate can further perpetuate this acid-base disturbance.

In contrast, thiazide diuretics can also cause metabolic alkalosis through somewhat similar mechanisms but generally have a lesser impact compared to loop diuretics. Potassium-sparing diuretics, on the other hand, tend to retain potassium and can lead to metabolic acidosis rather than alkalosis. Carbonic anhydrase inhibitors primarily lead to a metabolic acidosis due to increased bicarbonate excretion. Thus, the well-established mechanism of loop diuretics directly correlates with the