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* hyperkalemia
 #132845  
  saonew - 10/27/06 10:58
 
  A 70-year-old man with diabetes mellitus and hypertension
has the following serum chemistries:
Electrolytes (mmol/L): Na+138; K+5.0; Cl- 106;
HCO-3 20
Glucose: 11 mmol/L (200 mg/dL)
Creatinine: 176 micromol/L (2.0 mg/dL)
Which of the following may contribute to worsening
hyperkalemia?
(A) Propranolol
(B) Verapamil
(C) Theophyllin
(D) Carbenicillin
(E) Hydrochlorothiazide
 
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* Re:hyperkalemia
#530840
  vl2ss - 10/27/06 11:00
 
  E) Hydrochlorothiazide  
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* Re:hyperkalemia
#530848
  step1_ca - 10/27/06 11:06
 
  a????  
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* Re:hyperkalemia
#530849
  cd45 - 10/27/06 11:07
 
  a????  
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* Re:hyperkalemia
#530883
  saonew - 10/27/06 11:18
 
  The answer is A.
This man’s electrolyte pattern is consistent with a hyporeninemic hypoaldosteronism state, or type IV renal tubular acidosis.

The defect is believed to be due to an insufficiency of both angiotensin- and adrenal mineralocorticoid-secreting capacity. Inhibition of the renin-angiotensin system by beta-adrenergic blockade such as propranolol can cause hyperkalemia;
in addition, nonsteroidal anti-inflammatory agents or angiotensin-converting enzyme (ACE)
inhibitors may also lead to hyperkalemia.

The use of carbenicillin, theophyllin, and hydrochlorothiazide promote the loss of potassium through the distal renal tubule.

Calcium channel blockers such as verapamil have no significant effect on serum potassium concentrations at the usual doses.
 
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* Re:hyperkalemia
#530902
  pashna23 - 10/27/06 11:25
 
  c??? since its like a diuretic causing salt and water loss  
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* Re:hyperkalemia
#530908
  saonew - 10/27/06 11:26
 
  hi pashna:)))  
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* Re:hyperkalemia
#530915
  pashna23 - 10/27/06 11:29
 
  ok i completely didnt diagnose this! im such a doofus!:) hi sao!!!  
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* Re:hyperkalemia
#530918
  pashna23 - 10/27/06 11:31
 
  i need to look this up more but how does this guy have HT if hes hyporenemic and has hypoaldosteronism?  
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* Re:hyperkalemia
#530936
  saonew - 10/27/06 11:41
 
  http://medicine.ucsf.edu/housestaff/Chiefs_cover_sheets/renal%20tubular%20aci...cidosis';  
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* Re:hyperkalemia
#530940
  pashna23 - 10/27/06 11:43
 
  thank u sao !  
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