A 73-year-old woman - pacemaker

[ArchivalUser]

and hydrochlor causes high B/glucose level.remember HyperGLUC(side effects of hydro) from FA step 1

[ArchivalUser]

never mind,thot ,thot 194 b/glucose..its just 94

[ArchivalUser]

nswer and Critique (Correct Answer = D)
Key Point
Hydrochlorothiazide can cause severe hyponatremia.

Hydrochlorothiazide is a common cause of hyponatremia in the outpatient setting. Thiazide diuretics work at the level of the cortical collecting duct. Therefore, these agents maintain urinary concentrating capacity but not diluting capacity, which makes them prone to cause hyponatremic encephalopathy. By inducing relative volume depletion, antidiuretic hormone secretion is stimulated, which leads to urinary concentration and water retention. Conversely, loop diuretics act in the ascending limb of Henle and therefore impair both urinary concentrating and diluting capacity. To prevent this complication, patients should weigh themselves before and 48 hours after initiating therapy with these agents. If a patient does not lose weight or gains weight after initiation of a thiazide diuretic, he or she has a high risk for developing hyponatremic encephalopathy.

Furosemide acts on the ascending limb of Henle on the Na-K-2Cl transporter, which causes a tremendous increase in the distal flow and brisk increase in urine output that can œwash out the corticomedullary concentration gradient that is necessary for urinary concentrating capacity. By increasing the flow of solutes to the distal tubule, urinary diluting capacity is similarly impaired because the reabsorptive mechanisms cannot handle the tremendous flow of solutes. Theoretically, furosemide therapy would significantly increase water intake because urinary diluting capacity is impaired. Therefore, hyponatremia can result, although this presentation is rare.

Acetazolamide acts in the proximal tubule as a carbonic anhydrase IV inhibitor. Blocking this enzyme in the proximal tubule impairs bicarbonate reabsorption but not diluting capacity and is most often associated with hypokalemia and metabolic acidosis. Spironolactone is not associated with the development of hyponatremia. However, this agent acts in the kidney as a potassium-sparing diuretic and frequently is associated with hyperkalemia. Amiloride also is not associated with hyponatremia. Like spironolactone, this agent is a potassium-sparing diuretic. However, amiloride acts by blocking epithelial sodium channels important for potassium secretion in the distal tubule.