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ase A 62-year-old woman is being treated for chronic congestive heart failure. She has been put on hydrochlorothiazide therapy. Her serum electrolyte levels are being monitored and show a persistent hypokalemia. Question The addition of what to her therapeutic regimen would be most appropriate? Correct answer: Amiloride Explanation Amiloride is a potassium-sparing diuretic. Its diuretic effect is not very potent; therefore, it is good to use in combination with other diuretics. Acetazolamide is a carbonic anhydrase inhibitor. It causes a mild diuresis, a marked elevation of urinary pH, and a significant loss of potassium. Furosemide is a loop diuretic. It has a rapid onset of action and is a potent diuretic. However, it also causes potassium depletion and would only worsen the hypokalemia. Indapamide is a thiazide analog with a long duration of action. If anything, it would exacerbate the hypokalemia. Mannitol is an osmotic diuretic and would not be recommended in this patient. Furthermore, it would not have a potassium-sparing effect. Case A 42-year-old man presents with lower extremity swelling. His past medical history and review of symptoms is otherwise negative. The patient looks comfortable, with vitals showing the following: BP 142/91 mm Hg, HR 90 beats/min, RR 16 breaths/min, T 98°F, height 5'9'', and weight 158 lb. His examination is only remarkable for 2+ pitting edema in the lower extremities. The patient is counseled on a low-salt diet. The abnormal laboratory values are as follows: Lab Result Urinalysis 3+ protein, coarse granular casts, 2 - 5 WBCs, 0 - 2 RBCs Serum albumin 2.1 gm/dL Serum creatinine 2.0 mg/dL Serum BUN 18 mg/dL Hemoglobin 12.1 gm/dL Question What should be the next step in the management of this patient? Correct answer: