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Hyperkalaemia from potassium-sparing diuretic — DGM MCQ

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HardPolypharmacyHyperkalaemia from potassium-sparing diureticDGM

An 89-year-old man with heart failure is admitted with dizziness and potassium 6.1 mmol/L. He takes ramipril, spironolactone, furosemide, bisoprolol and co-codamol. Creatinine has risen from 110 to 190 micromol/L after diarrhoea. Which medication should be reviewed?

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Correct answer: B — Spironolactone

Spironolactone can cause clinically significant hyperkalaemia, especially with ACE inhibitors, dehydration and AKI. Ramipril also contributes, but spironolactone is the medication most directly associated with dangerous potassium retention here. Intercurrent illness should trigger medication review of renally active drugs.

Reference: BNF; NICE NG106