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NBME 20 Answers

nbme20/Block 3/Question#37 (36.0 difficulty score)
A 62-year-old man with alcohol-induced liver ...

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submitted by sweetmed(144),
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submitted by hayayah(1081),
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iaCnllic sue of rpgsKni-a s:ciditure

  • tnsHeeiplomorryasd
  • K+ opiltneed
  • FH
  • hictpae seiacts ent(prcsoiaooln)
  • cnoergehnpi DI airmeld)o(i
  • ngdtnoaaiern
redvelvet  Patients with hepatic ascites have hyperaldosteronism; because the intravascular volume is escaped to third space(ascites). So adding spironolactone is a good choice. +3  
champagnesupernova3  Always combine a K+ losing diuretic with a K+ sparing diuretic +11  
bryno20  My rational was a bit different. The patient likely has hepatorenal syndrome leading to a the ascites and decreased GFR. All diuretics, except for the steroids (eg, spironolactone), require secretion into the PCT in a GFR-dependent manner; for this reason, patient's with renal impairment show best success the steroid diuretics since their action is independent of renal function and GFR. +  
utap2001  RAAS system is increased in hepatic disease and HF, ACEI or ARB are good choices in diuresis therapy. +