A male patient is receiving furosemide therapy for the management of hypertension. After some days patient complains for muscle weakness, fatigue and myalgia. All of the clinical findings may suggest?

1. A

   Hyperkalemia

2. B

   Hypokalemia

3. C

   Hypocalcaemia

4. D

   Hypercalcaemia

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

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• Furosemide is a loop diuretic that increases the renal excretion of potassium.
• This potassium-wasting effect can lead to hypokalemia, which is a state of low potassium in the blood (serum level below 3.5 mEq/L).
• The patient's symptoms of muscle weakness, fatigue, and myalgia are hallmark clinical manifestations of hypokalemia, as potassium is essential for normal neuromuscular function.
• Therefore, the clinical findings strongly suggest hypokalemia as the underlying cause.

Why Other Options Were Wrong

• Option A: Hyperkalemia (high potassium) is incorrect because furosemide is a potassium-wasting diuretic, meaning it causes potassium loss, not retention.
• Option C: While loop diuretics can increase urinary calcium excretion, the patient's symptoms (generalized weakness, fatigue) are not the classic signs of hypocalcaemia. Hypocalcaemia typically presents with neuromuscular irritability, such as tingling, numbness, and tetany.
• Option D: Hypercalcaemia (high calcium) is incorrect. Furosemide promotes calcium excretion and is sometimes used as a treatment for hypercalcemia. Thiazide diuretics, not loop diuretics, are associated with causing hypercalcemia.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Adverse effects of loop diuretics and associated electrolyte imbalances in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Nurses must monitor serum potassium levels for patients on loop diuretics and be vigilant for signs and symptoms of hypokalemia.
• Patient education is critical. Patients should be taught to report symptoms like muscle weakness, cramping, or palpitations immediately.
• Dietary counseling may be necessary to encourage intake of potassium-rich foods (e.g., bananas, oranges, potatoes, spinach) to counteract urinary losses, or a potassium supplement may be prescribed.

How to Approach the Question

• First, identify the key elements in the clinical scenario: the drug (furosemide), the patient's condition (hypertension), and the new symptoms (muscle weakness, fatigue, myalgia).
• Recall the pharmacological class and mechanism of action of furosemide. It is a loop diuretic.
• Access your knowledge about the major side effects of loop diuretics. The most common and clinically significant side effect is electrolyte imbalance, particularly potassium loss (hypokalemia).
• Compare the patient's reported symptoms with the known signs of hypokalemia. Muscle weakness, fatigue, and myalgia are classic signs.
• Evaluate the other options. Rule them out based on the known effects of furosemide (it doesn't cause hyperkalemia or hypercalcemia) and the symptom presentation (not typical for hypocalcemia).
• Conclude that hypokalemia is the most logical explanation for the patient's clinical presentation.

Concept Tested & Keywords

• Concept Tested: Adverse effects of loop diuretics and associated electrolyte imbalances
• Stem keywords: furosemide, hypertension, muscle weakness, fatigue, myalgia
• Lead-in keywords: suggest
• Clinical cues: Patient receiving furosemide therapy, which is a loop diuretic known to cause potassium loss.
• Clinical cues: Patient presents with classic symptoms of hypokalemia: muscle weakness, fatigue, and myalgia.

Question ID

QY6jvsSOalEMmD2sD7YSfN

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 61-63

E6 Medicine Harrison 22e Part 1 p. 397-399