A patient with heart failure on multiple therapies develops acute gastroenteritis with vomiting. Which medication should be stopped temporarily to reduce risks?

• A. Ramipril
• B. Amlodipine
• C. Bisoprolol
• D. Indapamide

Answer: (A)

When a patient with heart failure develops acute gastroenteritis with vomiting, they are at risk of significant dehydration and electrolyte disturbances. In this situation, preserving kidney perfusion becomes crucial. ACE inhibitors lower the pressure inside the glomerulus by dilating the efferent arteriole. If volume status is reduced from vomiting, this effect can further decrease glomerular filtration rate and precipitate acute kidney injury, and it can also contribute to hyperkalemia in the setting of electrolyte imbalances. Temporarily stopping this medication helps protect renal function and stabilize potassium levels during the illness.

The other drugs don’t pose the same immediate risk to renal perfusion in this context. A calcium channel blocker mainly affects blood pressure and perfusion differently and isn’t as directly implicated in acute kidney injury during dehydration. A beta-blocker could worsen symptoms if there’s hypotension or reduced cardiac output, but the pressing danger here is impaired renal function from the ACE inhibitor during volume depletion. A diuretic could worsen dehydration and electrolyte loss, but the scenario’s key risk is the ACE inhibitor’s effect on renal hemodynamics during acute illness.