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A 55-year-old patient with severe posthepatitis cirrhosis is started on a diuretic for another condition. Two days later he is found in a coma. The drug most likely to cause coma in this patient is

1. Acetazolamide
2. amiloride
3. furosemide
4. hydrochlorothiazide
5. spironolactone

3?

1.

1 shud be the answer

can u please explain why?

pl ans sage

1. is right answer.
Patients with severe liver dysfunction are unable to synthesize urea efficiently and mainly rely on renal excretion of ammonium ion to get rid of nitro-wastes. CA inhibitors cause metabolic acidosis and urinary alkalosis, the later promotes NH4+ convertion into NH3 which is repidly reabsorbed.