Paper I — 2023 July (Supplementary) (2010 Scheme) — Q14
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Paper I
2023 July (Supplementary) (2010 Scheme) · 40 marks · 120 min
Question
Furosemide/Spironolactone in cirrhosis liver
Q140.3 marksShort Answers
Answer
Spironolactone is the appropriate first-line choice — cirrhotic ascites is driven substantially by secondary hyperaldosteronism (reduced hepatic clearance of aldosterone plus RAAS activation from effective arterial underfilling), so an aldosterone antagonist directly addresses the underlying mechanism. Furosemide alone would not counter the aldosterone-driven Na⁺ retention and carries a higher risk of electrolyte disturbance/hepatic encephalopathy-precipitating hypokalemia in this setting; it is typically added to spironolactone rather than used first, once diuresis with spironolactone alone is insufficient.
