TIL: Loop diuretics worsen metabolic alkalosis

Loop diuretics can worsen metabolic alkalosis mainly because they increase secretion of chloride, which draws H+ into the urine and promotes resorption of bicarb. This is a diagram that my senior resident gave me to demonstrate this. Look to the green NKCC transporter that is blocked by loop diuretics and then the intercalated cells where H+ is excreted. One thing we didn't full understand is if your total body chloride is up, and RAAS isn't activated because you're volume overloaded, this should be enough to prevent alkalosis.

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