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Old 03-26-2012
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Liver Cirrhosis complication next step...confusing

A 52-year-old woman with cirrhosis presents with increasing abdominal distension. Her treatment regimen
was amended three days ago, when furosemide was added to spironolactone and sodium/water
restriction. However, her distension persists, and today she is very somnolent and has passed very little
urine. Her past medical history is remarkable for chronic hepatitis type B, cirrhosis, encephalopathy, and 2
bleeding episodes from esophageal varices; the bleeding was controlled with sclerotherapy. Her temperatun
is 36.5C (97.6F), blood pressure is 90/60 mm Hg, pulse is 80/min, and respirations are 18/min. Abdominal
examination shows distension, shifting dullness, and no tenderness; bowel sounds are present. Laboratory
studies show:
Hemoglobin 11.0 g/L
  • Leukocyte count 3,500/mm3
  • Serum sodium 125 mEq/L
  • Serum potasium 5.5 mEq/L
  • Chloride 103 mEq/L
  • Blood urea nitrogen 60 mg/dL
  • Serum creatinine 1.8 mg/dL
  • Prothrombin time 18 sec
  • Partial thromboplastin time 35 sec

Urinalysis shows no abnormalities. Ultrasound of the kidney is unremarkable. Which of the following is the
most appropriate next step in management?
A. Increase the dose of furosemide to its maximum
v B. Careful volume loading and discontinuation of furosemide and spironolactone
C. Tapping of ascites
D. Renal biopsy

please give detailed expln to this q...very confusing to me...
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Old 03-26-2012
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i am going to guess and go with B. this is because she has hyponatremia, evidence of dehydration ? renal insuffieciency because of the rise in BUN/Cr ratio, she is becoming hyperkalemic so i think its time to stop the spirinolactone. i think the lady is having encaphalopathy, and dehydration is a cause?
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Old 03-26-2012
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answer. B,
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Old 03-26-2012
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am between B/C....but tapping is done only in cases where the patient is uncomfortable / respiratory difficulty due too much fluid uplifting the diaphragm
etc...i dont see any difficulty in this patient concerned to ascitis

so i go for hydration
reasons is hypotensive
2.pre-renal azotemia(bun/cr>20:1)(main cause is dehydration)
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Gastroenterology-, Internal-Medicine-, Step-2-Questions

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