WBR0375
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| Author | [[PageAuthor::( Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D. and Alison Leibowitz [1])]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Renal |
| Prompt | [[Prompt::A 68-year-old man with a significant history of alcoholism presents to the emergency department (ED) with an altered mental status. He is unable to provide further history. His daughter explains that the patient lives alone and has never visited his primary care physician in the 8 years. Physical examination in the ED is remarkable for fetor hepaticus, spider nevi, and gynecomastia. The patient's stomach is severely distended with shifting dullness. Following appropriate work-up, he is diagnosed with hepatic cirrhosis. At discharge, the patient is prescribed furosemide and spironolactone for his ascites. The patient should be monitored for which of the following electrocardiogram (ECG) changes following spironolactone administration?]] |
| Answer A | AnswerA::Two independent rhythms of P and QRS complexes |
| Answer A Explanation | [[AnswerAExp::Third degree AV block is not classically associated with spironolactone therapy. AV blockades are often observed among patients administered beta blockers and calcium channel blockers.]] |
| Answer B | AnswerB::Saw tooth appearance |
| Answer B Explanation | [[AnswerBExp::A saw tooth appearance is a characteristic electrocardiographic description of atrial flutter. Administration of spironolactone is not commonly associated with atrial flutter.]] |
| Answer C | AnswerC::Peaked T waves |
| Answer C Explanation | [[AnswerCExp::Peaked T waves on ECG are characteristic of hyperkalemia, a common adverse effect associated with administration of spironolactone (potassium-sparing diuretic).]] |
| Answer D | AnswerD::ST-segment elevation in leads I and aVL |
| Answer D Explanation | AnswerDExp::ST-segment elevation is not typically associated with spironolactone administration |
| Answer E | AnswerE::Prolonged PR interval |
| Answer E Explanation | AnswerEExp::Prolonged PR interval is characteristic of first degree AV block. Spironolactone is not classically associated with first degree AV blockade. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::Patients with advanced hepatic cirrhosis are often prescribed diuretics, such as furosemide and spironolactone, to relieve the fluid retention and ascites. Spironolactone is a competitive aldosterone receptor antagonist and a potassium-sparing diuretic. It is an effective treatment for patients with severe heart failure and ascites due to hepatic failure. Following initiation of spironolactone therapy, serum potassium concentrations should be periodically measured to monitor for hyperkalemia. Hyperkalemia is a potential adverse effect of spironolactone therapy that results from the inhibition of the physiologic activity of aldosterone with spironolactone administration. Peaked T waves are typical ECG findings that are suggestive of hyperkalemia. Educational Objective: Spironolactone is a competitive aldosterone receptor antagonist and a potassium-sparing diuretic. It is an effective treatment for patients with advanced hepatic cirrhosis with ascites. Hyperkalemia is a common adverse effect of spironolactone therapy. Hyperkalemia typically manifests as peaked T waves on ECG. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Spironolactone, WBRKeyword::Potassium sparing diuretic, WBRKeyword::Diuretics, WBRKeyword::Electrocardiography, WBRKeyword::ECG, WBRKeyword::EKG, WBRKeyword::Peaked t waves, WBRKeyword::Cirrhosis, WBRKeyword::Hepatic failure, WBRKeyword::Ascites, WBRKeyword::Furosemide, WBRKeyword::Alcoholic liver disease, WBRKeyword::Adverse effect, WBRKeyword::Side effect, WBRKeyword::Monitoring |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |