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 promotes the excretion of water, sodium, chloride, and potassium from the body.
• The loss of potassium can lead to hypokalemia, a condition characterized by a low level of potassium in the blood (serum potassium less than 3.5 mEq/L).
• The patient's complaints of muscle weakness, fatigue, and myalgia are hallmark symptoms of hypokalemia, as potassium is essential for normal muscle function.
• Therefore, these clinical findings are highly suggestive of furosemide-induced hypokalemia.

Why Other Options Were Wrong

• Option A: Hyperkalemia is an elevated potassium level. Furosemide is a potassium-wasting diuretic, so it causes potassium loss, not retention. This makes hyperkalemia an unlikely outcome.
• Option C: Hypocalcemia is a low calcium level. While loop diuretics can increase calcium excretion, the primary symptoms are neuromuscular excitability like tingling, numbness, and muscle spasms (tetany), which are different from the patient's reported symptoms.
• Option D: Hypercalcemia is an elevated calcium level. Furosemide promotes calcium excretion and does not cause hypercalcemia. In fact, it can sometimes be used to treat hypercalcemia.

Related Visual

• Visual 1: Diagram illustrating the site of action of loop diuretics on the nephron, showing how potassium is excreted.
• Visual 2: Chart comparing the signs and symptoms of hypokalemia and hyperkalemia side-by-side.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Adverse effects of diuretic therapy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• It is a critical nursing responsibility to monitor for signs of electrolyte imbalances in patients receiving diuretics.
• Nurses must educate patients on furosemide to report symptoms like muscle weakness, cramps, or an irregular heartbeat immediately.
• Potassium levels should be monitored regularly through lab tests, and a potassium-rich diet or supplements may be prescribed to prevent or treat hypokalemia.

How to Approach the Question

• First, identify the drug mentioned in the scenario: Furosemide.
• Recall the pharmacological class of Furosemide, which is a loop diuretic.
• Remember the primary adverse effects associated with loop diuretics. The most common and significant one is potassium loss (hypokalemia).
• Analyze the patient's symptoms: muscle weakness, fatigue, and myalgia.
• Connect the drug's known side effect profile with the patient's clinical presentation. The symptoms are classic manifestations of hypokalemia.
• Evaluate the given options. Hypokalemia is the only option that logically connects the drug (furosemide) to the patient's symptoms.

Concept Tested & Keywords

• Concept Tested: Adverse effects of diuretic therapy
• Stem keywords: furosemide, hypertension, muscle weakness, fatigue, myalgia
• Lead-in keywords: suggest
• Clinical cues: The patient is on furosemide, a loop diuretic known to cause potassium loss.
• Clinical cues: The symptoms presented (muscle weakness, fatigue, myalgia) are classic signs of hypokalemia.

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