Review Question - QID 109420

A 69-year-old man presents to the emergency department with shortness of breath that has been worsening over the past month. He now has shortness of breath with simple activities and minor exertion. When he was unable to climb the stairs to his house today, he decided to come to the emergency department. The patient has a medical history of poorly managed diabetes mellitus, hypertension, end-stage renal disease, and obesity. His current medications include insulin, metformin, lisinopril, hydrochlorothiazide, and ibuprofen. The patient is notably non-compliant with his medications. An ECG and chest radiograph are normal. The patient had dialysis 2 days ago and attends most of his appointments. Laboratory values are seen below:

Serum:
Na+: 135 mEq/L
K+: 4.5 mEq/L
Cl-: 100 mEq/L
HCO3-: 19 mEq/L
Urea nitrogen: 79 mg/dL
Glucose: 75 mg/dL
Creatinine: 5.5 mg/dL
Ca2+: 9.2 mg/dL
Mg2+: 1.7 mEq/L
AST: 11 U/L
ALT: 11 U/L

Leukocyte count and differential:
Leukocyte count: 4,500/mm^3
Platelet count: 150,000/mm^3
Neutrophil: 54%
Lymphocyte: 25%
Monocyte: 3%
Eosinophil: 1%
Basophil: 1%

Hemoglobin: 8.2 g/dL
Hematocrit: 22%
Mean corpuscular volume: 82 µm^3

His temperature is 99.5°F (37.5°C), pulse is 89/min, blood pressure is 144/85 mmHg, respirations are 10/min, and oxygen saturation is 97% on room air. Which of the following is a side-effect of the long-term therapy that should be initiated in this patient?