Grapefruit-thiazide diuretic interaction

Dr. Kyriacou urges you to reconsider your answer. The presentation and labs fit rhabdomyolysis with acute kidney injury, suggested by severe myalgia, marked creatine kinase elevation, and a rise in creatinine. Hydrochlorothiazide is not significantly metabolized by CYP3A4, which metabolizes grapefruit juice, so grapefruit does not meaningfully raise its levels. If there was inhibition of thiazide metabolism, you would expect electrolyte disturbances, for example hypokalemia, that may produce cramps or weakness. Thiazides do not typically cause marked creatine kinase elevation and myoglobin‑mediated kidney injury. 

Please go back and re-consider. 

  • Presentation

Map: Mattias Garcia_ORU (1096)
Node: 20724
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  • Επίσκεψη ρουτίνας στον γενικό γιατρό
  • Reschedule without offering alternative solutions
  • Decision: Initial Approach
  • They remember fishing in the lake.
  • Costas and his father discuss at the park.
  • Ο2 & iv υγρά & σαλβουταμόλη. και αέρια αίματος
  • Ο2 & iv υγρά & σαλβουταμόλη.
  • Ο2 & iv υγρά & σαλβουταμόλη. και αέρια αίματος
  • Ο2 & iv υγρά & σαλβουταμόλη.
  • Κλινική εξέταση
  • Κλινική εξέταση
  • Εργαστηριακά 2
  • Pioglitazone
  • They remember fishing in the lake.
  • Presentation
  • Salbutamol (SABA)
  • Decreased entry of glucose into muscle cells
  • Increased entry of fatty acids into adipocytes
  • Costas and his father discuss at the park.
  • Amnestic exam
  • Use open-ended questions and clarify priority symptoms (pain, discharge, fever).
  • Grapefruit-thiazide diuretic interaction

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