Patient JD a 61-year-old widow, had long-standing hypertension that was unsatisfactorily controlled on a variety of agen

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Patient JD a 61-year-old widow, had long-standing hypertension
that was unsatisfactorily controlled on a variety of agents. Her
drug therapy included furosemide 40 mg once a day, amlodipine 10 mg
daily and a salt restricted diet. Following a routine review of her
therapy, ramipril 2.5 mg once daily was added to her treatment
regimen in an attempt to improve blood pressure control.
Patient JD was recently diagnosed with gastroenteritis. A week
after her diagnosis she presented to her local hospital accident
and emergency unit, with ongoing diarrhoea. Her BP was found to be
100/60 mmHg and serum biochemistry revealed creatinine levels of
225 micromol/L (50–120 micromol/L, Na+ 125 mmol/L (135–145 mmol/l)
and K+ 5.2 mmol/L (3.5–5.0 mmol/L).
QUESTIONS:
1. What was the likely cause and underlying mechanism to Patient
JD's problem?
2. What treatment should be given?