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hungrybox
jesus this answer was probably too long i'm sorry
+9
meningitis
I disagree. It's the complete thought process needed for many Thiazide/Loop question that can be thrown. Thanks.
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amirmullick3
This is what NBME should be providing with each question's correct answer! Thanks hungrybox!
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amirmullick3
@hungrybox did you mean "All of this DECREASED Na increases aldosterone activity."?
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pg32
Anyone care to explain why she feels she has, "lost [her] pep"? Is that due to the hypokalemia? Or hypercalcemia caused by the thiazides?
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cmun777
@madojo @pg32 I assumed between her hypokalemia (which can cause weakness/fatigue) and possible contraction alkalosis those were the most likely causes for the "lost her pep" comment. I think if they wanted to indicate hypercalcemia to differentiate if loop diuretics were also in the answer choices they would certainly give more context for hypercalcemia sx
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adong
there wasn't any loop diuretics...
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drdoom
`pep` actually comes from `pepper`; to `pepper` something (including a food dish!) is to make it more vigorous, to give it more kick, to vitalize it. so, to โlose oneโs pepโ is to lose oneโs vitality, feel fatigued, feel lackluster, etc. https://www.etymonline.com/word/pep
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submitted by โhungrybox(1277)
Hydrochlorothiazide is a thiazide diuretic => thiazide diuretics are associated with hypokalemia.
What other diuretics are associated with hypokalemia? Loop diuretics.
Why?
Inhibition of Na+ reabsorption occurs in both loop diuretics (inhibit NKCC cotransporter) and thiazide diuretics (inhibit NaCl cortransporter). All of this increased Na+ increases Aldosterone activity.
Relevant to this problem, Aldosterone upregulates expression of the Na+/K+ ATP antiporter (reabsorb Na+ into body, expel K+ into lumen). This results in hypokalemia in the body.
Hang on, there's more high yield info!
Aldosterone does one other important thing - activation of a H+ channel that expels H+ into the lumen.
So, given that this patient has hypokalemia, you know there is upregulation of Aldosterone. Do you think her pH would be high, or low? Exactly, it would be high because inc. Aldosterone => inc. H+ expelled into the lumen => metabolic akalosis.
Now you understand why both loop diuretics and thiazide diuretics can cause what's called "hypokalemic metabolic alkalosis."