A 48-year-old man with chronic hypertension on hydrochlorothiazide for 3 years presents with progressive muscle weakness and palpitations. Vital signs: BP 152/94 mmHg, HR 102/min, RR 16/min. Labs reveal Na+ 128 mEq/L, K+ 2.8 mEq/L, Cl− 92 mEq/L, and normal renal function. EKG shows T-wave flattening. He denies orthostatic symptoms. Which agent would most appropriately be added to his regimen to address this electrolyte disturbance?
- A)Acetazolamide, a carbonic anhydrase inhibitor
- B)Metolazone, a thiazide-like diuretic with enhanced potency
- C)Furosemide, a loop diuretic with stronger diuretic efficacy
- D)Spironolactone, a potassium-sparing diuretic that blocks aldosterone receptorsGABARITO
- E)Mannitol, an osmotic diuretic that preserves electrolytes
Explicação
The patient has hypokalemia and hyponatremia secondary to thiazide use. Spironolactone blocks aldosterone at the collecting duct, preventing potassium and sodium loss. This counteracts thiazide-induced electrolyte wasting and is a standard combination for hype... Ver explicação completa e trilha adaptativa →