A 67-year-old woman with acute decompensated heart failure presents with dyspnea and orthopnea. Vital signs: BP 160/95, HR 110, RR 22, SpO2 88%. She receives high-dose intravenous furosemide. Labs reveal creatinine 2.1 mg/dL (baseline 0.9) and BUN 45 mg/dL. The next day she reports bilateral tinnitus and high-frequency hearing loss. She denies recent aminoglycoside use. Which of the following best explains this adverse effect?
- A)Loop diuretics decrease uric acid excretion leading to tinnitus
- B)Loop diuretics directly injure the optic nerve
- C)Loop diuretics irreversibly block muscarinic receptors in the cochlea
- D)Loop diuretics cause autoimmune destruction of hair cells
- E)Loop diuretics can cause ototoxicity, especially at high dosesGABARITO
Explicação
Furosemide inhibits the Na K 2Cl cotransporter in the thick ascending limb and at high doses can cause ototoxicity, especially when combined with other ototoxic drugs. Tinnitus after aggressive loop diuresis is a classic board association. Ver explicação completa e trilha adaptativa →