An outpatient with heart failure with reduced ejection fraction is evaluated in the cardiology clinic. Her current medication regimen includes sacubitril-valsartan, carvedilol, and furosemide. To further optimize her guideline-directed medical therapy, the physician prescribes spironolactone. The patient is instructed to complete a laboratory blood draw in one week. Measurement of which of the following serum parameters is the most critical component of this planned follow-up evaluation?
- PotassiumCevap
- BMagnesium
- CUric acid
- DAlanine aminotransferase
- EProthrombin time
Cevap
Potassium
Spironolactone is a mineralocorticoid receptor antagonist (aldosterone antagonist) that prevents potassium excretion in the distal nephron. When it is co-administered with other medications that block the renin-angiotensin-aldosterone system (such as sacubitril-valsartan, ACE inhibitors, or ARBs), the risk of severe hyperkalemia is markedly elevated. Standard clinical guidelines mandate checking serum potassium and renal function (creatinine) approximately 1 to 2 weeks after initiating or titrating spironolactone to prevent potentially fatal cardiac arrhythmias.
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Anahtar Kavram
Patients initiated on mineralocorticoid receptor antagonists (e.g., spironolactone), especially those on concurrent renin-angiotensin-aldosterone system inhibitors, require close monitoring of serum potassium and creatinine within 1 to 2 weeks to prevent life-threatening hyperkalemia.