A 34-year-old man presents to a base camp medical station after ascending rapidly from 1,400 m to 4,200 m over 18 hours during a Himalayan trekking expedition. He reports a throbbing bifrontal headache, nausea, generalized fatigue, and lightheadedness that began approximately 6 hours after arrival. He has no significant past medical history and takes no regular medications. On examination, his temperature is 37.1°C, blood pressure is 138/84 mmHg, heart rate is 102 beats/min, respiratory rate is 18 breaths/min, and oxygen saturation is 88% on room air. Arterial blood gas analysis reveals a pH of 7.45 and a mildly elevated bicarbonate of 26 mEq/L, consistent with early respiratory alkalosis. The expedition physician initiates a medication that inhibits carbonic anhydrase in the proximal tubule, causing bicarbonate diuresis and a mild compensatory metabolic acidosis that reflexively stimulates ventilation and improves oxygenation. Which of the following drugs was most likely prescribed?

  1. A)Hydrochlorothiazide
  2. B)Furosemide
  3. C)Mannitol
  4. D)Spironolactone
  5. E)AcetazolamideGABARITO

Explicação

Acetazolamide inhibits carbonic anhydrase, causing bicarbonate wasting and mild metabolic acidosis. This acidosis promotes hyperventilation and is useful for prevention and treatment of acute mountain sickness. The proximal tubule mechanism and altitude contex... Ver explicação completa e trilha adaptativa →

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