A 68-year-old woman presents for a routine check-up. Her only complaint is that she occasionally experiences a little swelling in her ankles. Her serum potassium is 3.5 mEq/L, so the physician wants to avoid unnecessary potassium losses. Which of the following diuretics would be most appropriate for this patient?
Potassium is responsible for maintenance of intracellular tonicity, transmission of nerve pulses, contraction of muscle (striated and smooth), and maintenance of renal function. The normal blood level of potassium ranges from 3.5 to 5.0 mEq/L. In potassium depletion, a decrease in the blood potassium level by 1 mEq/L equals a loss of 100-200 mEq from potassium stores in the body. Depletion can result in the development of muscular weakness, paralysis, and mental confusion. Since this patient is borderline hypokalemic, she should receive a potassium-sparing diuretic, such as spironolactone, amiloride, or triamterene. These agents are all indicated for the treatment of edematous states as well as the prophylaxis and treatment of hypokalemia. These agents are commonly combined with other non-potassium-sparing diuretics to prevent the appearance of hypokalemia during therapy. Furosemide is a loop diuretic indicated for the treatment of edematous states in hypeension and is commonly associated with the development of hypokalemia. Hydrochlorothiazide, indapamide, and metolazone are thiazide diuretics indicated for the treatment of edematous states in hypeension and are also commonly associated with the development of hypokalemia.
Furosemide
Hydrochlorothiazide
Indapamide
Indapamide