Metolazone hypokalemia with

The answer is c. (Hardman, pp 704-706J Triamterene produces retention of the K ion by inhibiting in the collecting duct the reabsorption of Na, which is accompanied by the excretion of K ions. The loop diuretics furosemide and bumetanide cause as a possible adverse action the development of hypokalemia. In addition, thiazides (e g, hydrochlorothiazide) and the thiazide-related agents (e.g., metolazone) can cause the loss of K ions with the consequences of hypokalemia. Triamterene can be given with a loop diuretic or thiazide to prevent or correct the condition of hypokalemia. 

The most important side effects of the thiazide diuretics, chlorthalidone, furosemide, ethacrynic acid and metolazone are potassium losses with resultant hypokalemia, and hyperuricemia. Hyperuricemia may result in acute attacks of gouty arthritis in individuals with a gouty diathesis. 

In order to correct potassium losses and the consequent diuretic-induced hypokalemia, spironolactone or triamterene can be successfully combined with the thiazide, metolazone, chlorthalidone, furosemide or ethacrynic acid. 

Fluid overload occurs commonly in patients with renal failure, often in the absence of associated heart disease. If salt and water intake is not controlled in the patient who is oliguric or anaemic, plasma volume and symptoms of congestive heart failure ensue. Hypertension and coronary heart disease with increasing age contributes to the congestive heart failure. Diuretics like loop-diuretics or metolazone may be of value. Digitalis should be used with caution in patients on dialysis as cardiac arrhythmias may ensue in patients receiving dialysis in the presence of hypokalemia. 

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