American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be monitored in patients with ascites associated with cirrhosis after beginning treatment with spironolactone and furosemide?

1. Blood pressure and respiratory rate

2. Serum creatinine and electrolyte levels

3. Liver function tests and international normalized ratio

4. Urine output and weight

The correct answer is: Serum creatinine and electrolyte levels

Monitoring serum creatinine and electrolyte levels in patients with ascites associated with cirrhosis who are being treated with spironolactone and furosemide is critical because these medications can significantly affect renal function and electrolyte balance. Spironolactone is a potassium-sparing diuretic that can lead to hyperkalemia, particularly in patients with compromised kidney function or concurrent use of other medications that affect potassium levels. Additionally, the combination of a diuretic therapy can lead to changes in renal blood flow and potentially worsened renal function, indicated by rising serum creatinine levels. Electrolyte levels, particularly sodium and potassium, should also be carefully monitored as diuretics can cause electrolyte imbalances. For example, furosemide can cause hypokalemia, while spironolactone can lead to hyperkalemia. By regularly checking these parameters, clinicians can ensure that the treatment is effective while minimizing the risk of complications related to renal function and electrolyte disturbances. Other choices relate to different aspects of patient care, like blood pressure and respiratory rate, liver function, or fluid balance, but the most immediate concerns with this specific treatment regimen focus on kidney function and electrolytes.