ootscootDoes anyone know why she would be presenting NOW after being on the thiazide for 10 years?+9
nnasser33This question was frustrating because it is clear that she is volume depleted given her orthostatic BP presentation, which could be caused by both the Thiazide and alcohol use (suppression of ADH release). You can certainly say her presentation is the result of an "adverse drug effect" but how can you completely rule out orthostatic hypotension and dehydration as possible answers? +2
cbrelandOrthostatic hypotension would refer to a significant decrease in blood pressure when standing. Her BP is low sitting and standing+3
cbreland@nnasser33 I was stuck between the two answers as well, but I remembered a similar question on another NBME related to that explanation ^+
mmizellHer BP also only dropped by 6 systolic/1 diastolic from sitting to standing. Orthostatic hypotension is defined as a drop >20/10.+8
helenweiI also think with dehydration her Hct would be higher+6
shieldmaiden@ootscoot The longer you are exposed to Thiazide diuretics the higher the probability of adverse effects+1
yesaI'll also note we are not shown her Ca2+ levels, they could be high, explaining fatigue and muscle weakness...also due to long term thiazide use +1
chaosawaitsDid anyone else have IDA as a top differential due to her excessive alcohol use, low Hct, and low K+, and so was thinking underlying gastrointestinal bleeding?+
chaosawaitsIt seems very strange to me that we are to ignore the fact that this woman drinks a MINIMUM of 5 beers every night and focus on a diuretic that she has been using for 10 years seemingly without issue.+1
leemaxlook at potassium values, there is your answer.+
leemaxlook at potassium values, there is your answer.+
submitted by โlpp06(41)
Treated with a thiazide diuretic for HTN with measured hypokalemia, hypotension and decreased Hgb
Thiazide increases Na+ delivery to collecting ducts, increases K+ secretion, causing hypokalemia - which will lead to muscle weakness.
Low blood pressure may be sign of volume depletion from the diuretic
Low Hgb/Anemia due to chronic alcohol abuse (macrocytic, non-megaloblastic anemia)