Diuretic-Associated Electrolyte Imbalances in Cardiovascular and Renal Disorders: A Clinical Pharmacists' Perspective

AbstractDiuretics are among the most widely prescribed drug classes and form a cornerstone of therapyfor hypertension, heart failure, chronic kidney disease, and other edematous states. Theirmechanism of action, which relies on inhibition of sodium reabsorption at specific sites along thenephron, predisposes patients to a predictable spectrum of electrolyte and acid-base disturbances,including hyponatremia, hypokalemia, hyperkalemia, hypochloremia, and changes in serumbicarbonate. These disturbances are common, frequently under-recognized, and capable of causingserious morbidity, including cardiac arrhythmia, falls, cognitive impairment, and death. Thisnarrative review synthesizes current literature on the mechanisms, risk factors, and clinicalconsequences of diuretic-induced electrolyte abnormalities and evaluates the evidence supportingan expanded role for clinical pharmacists in their prevention and management through medicationreview, dose optimization, structured electrolyte monitoring, identification of drug-relatedproblems, patient counselling, and multidisciplinary collaboration. Available controlled evidence,though still maturing, consistently favors structured pharmacist involvement in diuretic-treatedpopulations, supporting wider adoption of pharmacist-led monitoring protocols and collaborativeprescribing models.