NBME 20 Answers ↦
(31.9 difficulty score)
A 62-year-old man with alcohol-induced liver ...
Patients with hepatic ascites have hyperaldosteronism; because the intravascular volume is escaped to third space(ascites). So adding spironolactone is a good choice.
Always combine a K+ losing diuretic with a K+ sparing diuretic
My rational was a bit different. The patient likely has hepatorenal syndrome leading to a the ascites and decreased GFR. All diuretics, except for the steroids (eg, spironolactone), require secretion into the PCT in a GFR-dependent manner; for this reason, patient's with renal impairment show best success the steroid diuretics since their action is independent of renal function and GFR.