A 44-year-old man comes to the office due to swelling of the legs and abdomen. The patient has a history of alcohol-induced cirrhosis, and his ascites had been well controlled with furosemide. Over the past week, he has had increasing bilateral lower extremity and abdominal swelling despite taking a diuretic as prescribed. The patient reports no change in dietary sodium or water intake but states he has been taking over-the-counter ibuprofen after injuring his back recently. He stopped drinking alcohol 2 years ago and does not use tobacco or illicit drugs. Physical examination shows 3+ bilateral lower extremity edema and moderate ascites. Which of the following changes most likely contributed to the acute deterioration in this patient's condition?

Question

A 44-year-old man comes to the office due to swelling of the legs and abdomen.  The patient has a history of alcohol-induced cirrhosis, and his ascites had been well controlled with furosemide.  Over the past week, he has had increasing bilateral lower extremity and abdominal swelling despite taking a diuretic as prescribed.  The patient reports no change in dietary sodium or water intake but states he has been taking over-the-counter ibuprofen after injuring his back recently.  He stopped drinking alcohol 2 years ago and does not use tobacco or illicit drugs.  Physical examination shows 3+ bilateral lower extremity edema and moderate ascites.  Which of the following changes most likely contributed to the acute deterioration in this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis.  Patients with intravascular volume depletion (eg, cirrhosis) are dependent on the vasodilatory effects of prostaglandins to maintain adequate renal plasma flow and glomerular filtration.  NSAID use in this population reduces glomerular filtration rates and blunts the effects of loop diuretics, leading to sodium and water retention.

A 44-Year-Old Man Comes to the Office Due to Swelling