Question of the Week # 221

221 )  A 73-year-old white man with type 2 diabetes mellitus, hypertension, coronary artery disease is admitted with increasing shortness of breath and lower-extremity edema. A brain natriuretic peptide level is 1000 pg/ml. His medications include glyburide, aspirin, atorvastatin and enalapril. He is allergic to sulfonamides. On physical examination, he has bilateral crepitations more in the right chest. Extremity examination reveals 3+ edema bilaterally. An electrocardiogram reveals changes consistent with left venricular hypertrophy but no evidence of acute ischemia. Cardiac enzymes are negative. A chest x-ray reveals bilateral pulmonary edema. Pulse oximetry reveals a saturation of 89% on room air. The patient is started on oxygen by nasal cannula. Which of the following is the most appropriate next step in management?

A) Intubation

B) Intravenous Furosemide

C) Bilevel Positive Airway pressure (BIPAP)

D) Intravenous Ethacrynic acid

E) Cardiac catheterization.

6 Responses

  1. intravenous furosemide

  2. b

  3. b

  4. D…..Intravenous Ethacrynic acid

    Unlike the other loop diuretics, etacrynic acid is not a sulfonamide[1] and thus, its use is not contraindicated in those with sulfa allergies

  5. D.
    Ethacrynic acid.

  6. D:) Ethacrynic acid
    Patient has sulfa allergy.
    List of sulfonamides[edit]

    Child antibacterial drugs[edit]
    Pediazole[13]
    Antibacterial Drugs[edit]
    Short-acting
    Sulfamethoxazole
    Sulfisomidine (also known as sulfaisodimidine)
    Sulfadiazine
    Intermediate-acting
    Sulfacetamide[14]
    Sulfadoxine
    Ophthalmologicals
    Dichlorphenamide (DCP)
    Sulfonylureas (anti-diabetic agents)[edit]
    Carbutamide
    Acetohexamide
    Chlorpropamide
    Tolbutamide
    Tolazamide
    Glipizide
    Gliclazide
    Glibenclamide (glyburide)
    Glibornuride
    Gliquidone
    Glisoxepide
    Glyclopyramide
    Glimepiride
    Diuretics[edit]
    Acetazolamide
    Bumetanide
    Chlorthalidone
    Clopamide
    Dorzolamide
    Furosemide
    Hydrochlorothiazide (HCT, HCTZ, HZT)
    Indapamide
    Mefruside
    Metolazone
    Xipamide
    Anticonvulsants[edit]
    Acetazolamide
    Ethoxzolamide
    Sultiame
    Zonisamide
    Dermatologicals[edit]
    Mafenide
    Other[edit]
    Celecoxib (COX-2 inhibitor)
    Darunavir (Protease Inhibitor)
    Fosamprenavir (Protease Inhibitor)
    Tipranavir (Protease Inhibitor)
    Probenecid (PBN)
    Sotalol (Beta-blocker)
    Sulfasalazine (SSZ)
    Sumatriptan (SMT)
    Delavirdine (NNRTI)
    Tamsulosin (Flomax)

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