Which electrolyte imbalance is most likely to be seen with fludrocortisone (Florinef) therapy?

• A. Hypokalemia
• B. Hyperkalemia
• C. Hyponatremia
• D. Hypercalcemia

Answer: (A)

Fludrocortisone acts like aldosterone, boosting sodium reabsorption and potassium (and hydrogen) excretion in the distal nephron. This mineralocorticoid effect expands the extracellular fluid and can raise blood pressure, but it also drives potassium loss into the urine. The net electrolyte consequence is hypokalemia, not hyperkalemia. Hyponatremia would be unlikely because sodium is being retained, not depleted; hypercalcemia isn’t a typical outcome of this therapy. Monitoring should include potassium levels and signs of low potassium such as muscle weakness or arrhythmias, along with watching for fluid overload or hypertension from sodium retention.