Major
Established
Description
Furosemide-induced sodium depletion stimulates compensatory proximal tubular reabsorption of both sodium and lithium, raising lithium levels into the toxic range.
Mécanisme
Loop diuretics like furosemide deplete total body sodium; the kidney compensates by increasing proximal tubular reabsorption of sodium, and lithium (handled similarly to sodium) is reabsorbed in parallel.
Signification clinique
Lithium toxicity during furosemide therapy is well-documented; dehydration from high-dose furosemide compounds the risk further.
Prise en charge
Monitor serum lithium levels closely when initiating, changing, or discontinuing furosemide; ensure adequate sodium and fluid intake.