| Loop Diuretics | Furosemide, Bumetanide | ↓ Na⁺, ↓ K⁺, ↓ Mg²⁺, ↓ Ca²⁺ | Inhibit Na⁺-K⁺-2Cl⁻ cotransporter in thick ascending loop | Risk of metabolic alkalosis, arrhythmias |
| Thiazide Diuretics | HCTZ, Chlorthalidone | ↓ Na⁺, ↓ K⁺, ↓ Mg²⁺, ↑ Ca²⁺ | Inhibit Na⁺/Cl⁻ reabsorption in distal tubule | Hypercalcemia may benefit kidney stones |
| Potassium-Sparing Diuretics | Spironolactone, Amiloride, Eplerenone | ↑ K⁺ | Inhibit aldosterone or ENaC → ↓ K⁺ excretion | Risk of hyperkalemia, especially in CKD |
| ACE Inhibitors | Lisinopril, Enalapril | ↑ K⁺ | ↓ Aldosterone → ↓ K⁺ excretion | Monitor K⁺ and renal function closely |
| ARBs | Losartan, Valsartan | ↑ K⁺ | Similar to ACEIs | Safer in cough-prone patients vs ACEIs |
| NSAIDs | Ibuprofen, Naproxen | ↑ K⁺, ↓ Na⁺ | ↓ Renal perfusion → ↓ renin/aldosterone → ↑ K⁺; ↑ ADH effect | Risk of AKI, hyponatremia in elderly |
| Corticosteroids | Prednisone, Dexamethasone | ↓ K⁺, ↑ Na⁺ | Mineralocorticoid effects → Na⁺ retention, K⁺ loss | Can cause edema, hypertension |
| Insulin | – | ↓ K⁺ | Shifts K⁺ intracellularly via Na⁺/K⁺-ATPase | Monitor during DKA treatment |
| Beta-agonists | Albuterol, Salbutamol | ↓ K⁺ | Stimulates Na⁺/K⁺-ATPase → K⁺ shift intracellularly | Can cause tremors, tachycardia |
| Amphotericin B | – | ↓ K⁺, ↓ Mg²⁺ | Increases renal tubule permeability | High risk of nephrotoxicity |
| Digoxin | – | ↑ risk of toxicity in ↓ K⁺ or ↓ Mg²⁺ | Competes with K⁺ at Na⁺/K⁺-ATPase | Electrolyte imbalance = toxicity trigger |
| Laxatives (chronic use) | Senna, Bisacodyl | ↓ K⁺, ↓ Mg²⁺ | GI loss of electrolytes | Abuse can cause metabolic alkalosis |
| Calcineurin Inhibitors | Cyclosporine, Tacrolimus | ↑ K⁺, ↓ Mg²⁺ | Renal vasoconstriction & tubular toxicity | Monitor closely in transplant patients |
| Proton Pump Inhibitors (PPIs) | Omeprazole, Pantoprazole | ↓ Mg²⁺ | Impaired intestinal absorption of Mg²⁺ | Can lead to tetany, seizures |
| Heparin (chronic use) | – | ↑ K⁺ | Suppresses aldosterone → ↓ K⁺ excretion | Seen in prolonged or high-dose use |
| Carbamazepine, SSRIs | – | ↓ Na⁺ | SIADH → ↑ ADH → water retention | Watch for confusion, seizures |
| Desmopressin, MDMA, Cyclophosphamide | – | ↓ Na⁺ | Induce SIADH | Risk of severe hyponatremia, esp. in young women |
| Lithium | – | ↓ Na⁺, ↑ risk of nephrogenic DI | Affects ADH response in kidneys | Monitor Na⁺ & renal function routinely |
