Overview Snapshot A 32-year-old previously healthy man develops headache, fatigue, vomiting, and shortness of breath about 12 hours after arriving to Mt. Everest Base Camp. Over the next day, he develops mild difficulty walking, and confusion. He is seen by a physician who administers a medication and advises him to rest. His symptoms improve over the next 24-48 hours. (Acetazolamide) Mannitol Mechanism osmotic diuretic increases osmotic pressure of the glomerular filtrate this in turn impairs tubular reabsorption of water and electrolytes Clinical use oliguria which can result from shock and trauma drug overdose promotes urinary excretion of toxic substances glaucoma ↓ intraocular pressure increased intracranial pressure especially in the setting of cerebral edema Toxicity pulmonary edema congestive heart failure (CHF) exacerbation hypovolemia Contraindications anuria CHF Acetazolamide Mechanism carbonic anhydrase inhibitor blocks reabsorption of bicarbonate dissociation of carbonic acid into water and carbon dioxide in the proximal tubule prevented bicarbonate in the lumen then binds to sodium to form sodium bicarbonate which is excreted results in sodium bicarbonate diuresis and ↓ total body bicarbonate loss of bicarbonate results in metabolic acidosis loss of bicarbonate results in metabolic acidosis loss of bicarbonate results in metabolic acidosis loss of bicarbonate results in metabolic acidosis Clinical use glaucoma urinary alkalinization metabolic alkalosis altitude sickness increased intracranial pressure especially for idiopathic intracranial hypertension Toxicity hyperchloremic metabolic acidosis (non-anion gap) type 2 renal tubular acidosis hypokalemia neuropathy/parasthesias ↑ renal stone production calcium phosphate stones ammonia toxicity sulfa allergy
QUESTIONS 1 of 2 1 2 Previous Next (M1.RL.13.48) A 61-year-old male is given acetazolamide to treat open-angle glaucoma. Upon diuresis, his urine is found to be highly alkaline. Which of the following accounts for the alkaline nature of this patient’s urine? QID: 101002 Type & Select Correct Answer 1 Inhibition of chlorine reabsorption in the thick ascending loop of Henle 5% (12/254) 2 Inhibition of chlorine reabsorption in the distal convoluted tubule 8% (21/254) 3 Inhibition of acid secretion in alpha-intercalated cells 6% (15/254) 4 Inhibition of bicarbonate reabsorption in the proximal tubule 67% (170/254) 5 Inhibition of bicarbonate reabsorption in beta-intercalated cells 8% (21/254) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (M1.RL.13.6) A 56-year-old male with history of CHF presents to a trauma center following a motor vehicle accident. On arrival, his Glasgow Coma Scale score is 8, and he is found to have increased intracranial pressure. Mannitol is administered. Which of the following side effects of the drug would you most likely observe in this patient? QID: 100960 Type & Select Correct Answer 1 Blood dyscrasias 7% (36/515) 2 Seizures 19% (99/515) 3 Pulmonary edema 51% (263/515) 4 Arrhythmias 19% (98/515) 5 Restrictive cardiomyopathy 3% (13/515) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
All Videos (0) Renal | Proximal Tubule Diuretics Renal - Proximal Tubule Diuretics Listen Now 9:58 min 1/23/2023 7 plays 5.0 (1)