To prevent hypokalemia in a patient with ascites, which diuretic is potassium-sparing and may be ordered?

• A. Spironolactone (Aldactone)
• B. Furosemide (Lasix)
• C. Acetazolamide (Diamox)
• D. Bumetanide (Bumex)

Answer: (A)

Potassium-sparing diuretics are used in ascites from liver disease to prevent losing potassium while still removing excess fluid. Spironolactone is an aldosterone antagonist that acts in the collecting ducts to block sodium reabsorption and potassium excretion. By counteracting the hyperaldosteronism that often accompanies cirrhosis, it helps reduce fluid buildup without causing hypokalemia, and it’s commonly used for ascites (often alongside a loop diuretic to balance effects).

Other diuretics listed promote potassium loss. Loop diuretics like furosemide and bumetanide remove fluid but can lead to hypokalemia. Acetazolamide also tends to cause shifts that can worsen electrolyte imbalance and isn’t potassium-sparing. Monitor for hyperkalemia, though, when using spironolactone, especially with kidney issues or other potassium-increasing medications.