QuestionSBA
QuestionChoice
Gliclazide is a sulphonylurea used to treat type 2 diabetes. It is not known to cause hyperkalaemia.
50143
c
Gliclazide 80mg OD
QuestionChoice
This patient has hyperkalaemia. Ramipril is an angiotensin-converting enzyme inhibitor (ACE-i), a known adverse effect of ACE-is is hyperkalaemia.
50141
a
Ramipril 5mg
QuestionChoice
Metformin is a biguanide used to treat type 2 diabetes. It is not known to cause hyperkalaemia.
50142
b
Metformin 500mg BD
QuestionChoice
Co-amoxiclav is an antibiotic used to treat infections such as pneumonia. It is not known to cause hyperkalaemia.
50144
d
Co-amoxiclav 250/125mg TDS
QuestionChoice
Omeprazole is a proton pump inhibitor used to treat gastro-oesophageal reflux disease (GORD). It is known to cause electrolyte imbalances such as hypokalaemia, hyponatraemia, hypocalcaemia and hypomagnesia due to increased renal losses. This patient has hyperkalaemia so this is unlikely to have been caused by omeprazole.
50145
e
Omeprazole 40mg BD
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3608
ACE-i - hyperkalaemia
Topic
9
Internal Medicine
10076
Case Presentation: A 56-year-old gentleman is admitted to the acute medical unit with pneumonia. Weight 90kg. His Medications are listed (below). 




 **PMH**


 * Hypertension
 * GORD
 * Type II diabetes mellitus


 **On examination**


 * Chest: coarse crackles in left mid to lower zones.
 * HS S1 S2 + no added sounds
 * Abdo SNT
 * Temperature 38.1, BP 110/84, HR 96


 **Investigation**


||||
|---------------------------|:-------:|--------------------|
|Sodium|136mmol/L|135 - 145|
|Potassium|5.5 mmol/L|3.5 - 5.3|
|Urea|5 mmol/L|2.5 - 7.8|
|Creatinine|96 µmol/L|60 - 120|


Question: Which medication is most likely to have contributed to his electrolyte abnormality?
a