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Hypokalemia from diuretics — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Hypokalemia from diureticsUSMLE Step 3

A 64-year-old woman treated with chlorthalidone develops muscle cramps. Potassium is 3.0 mEq/L, bicarbonate is 32 mEq/L, and blood pressure is improved. Which of the following is the most likely explanation for this patient's findings?

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Correct answer: DRenal potassium wasting with metabolic alkalosis

Thiazide-type diuretics increase distal sodium delivery, promoting potassium and hydrogen ion loss with metabolic alkalosis.

Reference: 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM High Blood Pressure Guideline