BRCU 2025: Test Your Knowledge
A 47-year-old man with ESKD due to type 1 diabetes mellitus is noted to have worsening hypertension over the past 8 weeks and has been hypotensive and dizzy at his past two treatments. Today he complains of shortness of breath with exertion on walking in from the parking lot to the dialysis chair. He is adherent with in-center hemodialysis three times a week has a functional arteriovenous fistula, and recently has been cramping because his dry weight has been decreased in attempt to achieve better BP control. His anemia and renal osteodystrophy laboratory values remain at goal on therapy, and his monthly Kt/V has been 1.4–1.6 over the past year. He makes minimal urine. His medications are insulin, aspirin, carvedilol, irbesartan, minoxidil, and amlodipine.
Which should be your next step?
- Discontinue amlodipine
- Send him to the hospital for an emergent echocardiogram
- Increase his estimated dry weight because his BP is now controlled
- Add furosemide 80 mg twice daily to help treat his presumed pulmonary edema
Reference:
Akinleye, Akintayo, Yasser Jamil, and Pai Dogbey. "Minoxidil-Induced Pleuro-Pericardial Effusion with Tamponade." Cureus 15, no. 10 (2020):e46416. doi: 10.7759/cureus.46416
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