A hospitalized patient receives high-dose intravenous furosemide by rapid bolus while concurrently being treated with gentamicin. Two days later he complains of tinnitus and difficulty hearing conversation. The factor most responsible for this complication is:

• A Cumulative oral dose of the diuretic
• B Concurrent hypokalemia from diuresis
• C Rapid intravenous administration combined with another ototoxic agent ✓
• D Underlying age-related cochlear degeneration

Explanation

Loop diuretic ototoxicity is dose dependent and is most likely when large doses are given rapidly intravenously, producing high peak serum levels. Risk rises markedly when combined with other ototoxic drugs such as aminoglycosides, which act synergistically on stria vascularis function. Oral therapy rarely causes deafness, and correcting potassium does not prevent it.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.