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Last Update: 01/24/2025 08:27 AM
Current Deck: Geneeskunde::3e bachelor::Nier en spijs::ZSO 32: Nierfarmacologie::Shanna's Snelweg naar Succes
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Question
Commit #268356
A 70-year-old retired businessman with a history of chronic
heart failure has been taking digoxin and furosemide. He is
now admitted with vomiting, acute decompensatcd heart fail
ure, and metabolic derangements. He has marked peripheral
edema and metabolic alkalosis (pH, 7 .50 [normal 7.4]; pC02,
45 [37-45]; HC03, 36 [22-26]; Na\ 140 [135-145]).
Which of the following drugs is most appropriate for the treat
ment of his edema?
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Commit #268356
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(A) Acctazolamide
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(B) Digoxin
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(C) Eplerenone
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(D) Hydrochlorothiazide
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(E) T olvaptan
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Commit #268356
Katzung
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Commit #268356
Although acetazolamide is rarely used in heart failure, car
bonic anhydrasc inhibitors arc quite valuable in patients with
edema and metabolic alkalosis. The high bicarbonate levels
in these patients make them particularly susceptible to the
action of carbonic anhydrase inhibitors. This patient has both
high pH and bicarbonate. Digoxin is useful in chronic systolic
failure but is not first-line therapy and may cause vomiting,
with depletion of stomach acid and reduced serum chloride;
increasing the digoxin dose might cause arrhythmias. Tolvap
tan might be useful if the patient were hyponatremic. Hydro
chlorothiazide and eplerenone are not adequate for first-line
therapy of edema in acute heart failure. The answer is A