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Clinical Case for FMG Examination

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  • Clinical Case for FMG Examination
80-year-old lady with Hypertension and type2 DM is hospitalized with progressive exertional dyspnoea and orthopnoea. Since she is found to having wet lungs, she is started on loop diuretics. On day 4 of treatment she appears clinically euvolemic with JVP of 7 cm of water. However, while checking her labs you notice that her serum creatinine has spiked from 1.0 mg to 2.6mg. Which of the following is correct about this patient’s condition?
  1. Occult Diabetic nephropathy leads to type 1 RTA
  2. High dose loop diuretics trigger neurohormonal stimulation and cardiorenal syndrome
  3. Loop diuretics lead to hypokalemia and metabolic acidosis which affects renal perfusion
  4. Patient should have been better managed with Thiazides and beta blockers
The patient has developed acute Heart failure at presentation. She was placed on loop diuretics which have improved her pulmonary edema status. However, she has developed cardiorenal syndrome due to use of loop diuretics leading to rise of serum creatinine.
Choice A: Wrong: She is not having Diabetic nephropathy but cardiorenal syndrome and second diabetic nephropathy leads to type 4 RTA
Choice B: Wrong: Loop diuretics cause metabolic alkalosis and excess use can decrease renal perfusion.
Choice D: Wrong: Pulmonary edema requires loop diuretics. Thiazides are not used in acute CHF due to limited efficacy. Beta blockers are contraindicated in acute CHF.
The correct answer is choice B
Good luck and keep practising