A 45-Year-Old Man Is Evaluated in the Emergency Department for Severe

A 45-year-old man is evaluated in the emergency department for severe right flank pain.  He is tossing in the bed from the pain.  The patient has a history of hypertension, hyperlipidemia, and diet-controlled type 2 diabetes mellitus.  BMI is 43 kg/m².  Abdominal radiographs show no abnormalities, but CT scan shows a 5-mm stone in the right ureter and several smaller stones in both renal pelvises.  Urinalysis results are as follows: The patient subsequently passes a stone, and analysis shows it to be composed of 100% uric acid.  Besides high fluid intake, which of the following would be most helpful for this patient to prevent recurrent stones?

A) Calcium-restricted diet
B) Furosemide
C) High-protein diet
D) Hydrochlorothiazide
E) Potassium citrate

Correct Answer:

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