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Diuretic-Induced Electrolyte HE — RACP Adult Medicine MCQ

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ModerateGastroenterologyDiuretic-Induced Electrolyte HERACP Adult Medicine

A 62-year-old man with cirrhosis on lactulose presents with worsening confusion. He recently started spironolactone and furosemide for refractory ascites. Labs: Na⁺ 126 mmol/L, K⁺ 2.8 mmol/L, urea 18 mmol/L. He has been having only one bowel motion daily. What is the most likely precipitant?

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Correct answer: D — Electrolyte disturbance (hypokalaemia)

Hypokalaemia from diuretic therapy (furosemide) precipitates HE by promoting renal ammoniagenesis (hypokalaemia stimulates glutamine metabolism in renal proximal tubules, increasing ammonia production). Hyponatraemia and dehydration from over-diuresis further contribute. The constipation from reduced lactulose efficacy compounds the problem. Correction of electrolytes and reduction of diuretic doses is essential.

Reference: GESA – 2024 – HE; EASL 2024 Decompensated Cirrhosis