A 65-year-old woman on furosemide and hydrochlorothiazide for heart failure develops metabolic alkalosis (pH 7.50, HCO₃⁻ 36 mmol/L), hypokalaemia (K⁺

Question

A 65-year-old woman on furosemide and hydrochlorothiazide for heart failure develops metabolic alkalosis (pH 7.50, HCO₃⁻ 36 mmol/L), hypokalaemia (K⁺ 2.6 mmol/L), and hyponatraemia. Urine chloride is 55 mmol/L (while on diuretics). What is the most likely cause?

Accepted Answer

Diuretic use

Answer

Bartter syndrome

Answer

NG suction/vomiting (chloride-responsive)

Answer

Primary aldosteronism (chloride-resistant)

Answer

Milk-alkali syndrome

Diuretic-Induced Metabolic Alkalosis — RACP Adult Medicine MCQ

A 65-year-old woman on furosemide and hydrochlorothiazide for heart failure develops metabolic alkalosis (pH 7.50, HCO₃⁻ 36 mmol/L), hypokalaemia (K⁺ 2.6 mmol/L), and hyponatraemia. Urine chloride is 55 mmol/L (while on diuretics). What is the most likely cause?