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A 54-Year-Old Woman Comes to the Physician Because of Abdominal

Question 32

Multiple Choice

A 54-year-old woman comes to the physician because of abdominal distention and mild diffuse abdominal discomfort for the past week. She has not had nausea, vomiting, fever, or chills. She was diagnosed with alcoholic liver cirrhosis 2 years ago. Examination shows a protruding, distended abdomen that is dull to percussion with a positive fluid wave. Ultrasonography shows mild to moderate ascites. Appropriate treatment of the patient's condition is started. Four days later, the patient experiences palpitations and chest pain at home. She is brought to the emergency department, where her temperature is 37.3°C (99.1°F) , pulse is 182/min, respirations are 18/min, and blood pressure is 82/50 mm Hg. An ECG shows ventricular tachycardia. Initial laboratory studies show:
Serum
Na+ 131 mEq/L
K+ 2.9 mEq/L
Cl- 92 mEq/L
Bicarbonate 34 mEq/L
Urea nitrogen 42 mg/dL
Creatinine 4.8 mg/dL
Glucose 90 mg/dL
Ca2++ 8.1 mg/dL
Mg2++ 1.3 mEq/L
Phosphate 4.7 mg/dL
Arterial Blood Gas
PH 7.52
PCO2 45 mm Hg
PO2 90.2 mm Hg
She is successfully cardioverted to normal sinus rhythm. Which of the following treatments is most likely responsible for this patient's presentation?


A) Hydrochlorothiazide
B) Furosemide
C) Acetazolamide
D) Lisinopril
E) Spironolactone
F) Mannitol

Correct Answer:

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