A patient with hyperkalemia should avoid which diuretic due to potassium-sparing effects?

A patient with hyperkalemia should avoid which diuretic due to potassium-sparing effects?

• A. Spironolactone
• B. Hydrochlorothiazide
• C. Furosemide
• D. Acetazolamide

Answer: (A)

Potassium-sparing diuretics conserve potassium by reducing its excretion, so they can worsen hyperkalemia. Spironolactone blocks aldosterone receptors in the collecting ducts, which decreases potassium secretion and leads to potassium retention. In a patient with high potassium, this raises the risk further, so spironolactone should be avoided. The other diuretics listed promote potassium loss: hydrochlorothiazide and furosemide increase distal sodium delivery and potassium excretion, while acetazolamide causes bicarbonate diuresis with potential potassium loss.

Potassium-sparing diuretics conserve potassium by reducing its excretion, so they can worsen hyperkalemia. Spironolactone blocks aldosterone receptors in the collecting ducts, which decreases potassium secretion and leads to potassium retention. In a patient with high potassium, this raises the risk further, so spironolactone should be avoided. The other diuretics listed promote potassium loss: hydrochlorothiazide and furosemide increase distal sodium delivery and potassium excretion, while acetazolamide causes bicarbonate diuresis with potential potassium loss.