Uncontrolled HTN with low K+

Morning report with Dr.Tahir

51 yo AAM with PMH of HTN, noncompliant with medications, cocaine abuse presented to the clinic with high BP 270/150, blurry vision and headache.

What would you do?
Admit to ICU

Treat the BP immediately, start PO medications in the clinic.

Look for target organs damage on physical exam:
CV and pulmonary exam
Abdominal exam for bruit
Peripheral pulses

What labs would you order?
UA for RBC casts to r/o glomerulonephritis
Urine toxic screen
Uric acid
CPP (chest pain panel)

Lab work showed K+ 2.6, BUN 35, Cr 2.8.
Urine tox; negative for cocaineBaseline unknown.

What do you think about in terms of diagnosis now?
Hyperaldosteronism, Conn's syndrome

What is the workup for these abnormalities?
Plasma renin and serum aldosterone levels
Spot urine K+
Renal Doppler U/S -> if inconclusive then the next step is a renal flow scan

What did we find in this patient?
High plasma renin and high aldosterone levels

Final Diagnosis: Hypereninemic hyperaldosteronism

We have to find the cause...


Anonymous said...

why do u check uric acid level
anand damodaran

Anonymous said...

Uric acid traditionally has been associated with higher mortality in patients with HTN. There is no causal relationship however and the uric acid elevation in HTN patients is probably a by-pass product of obesity. Uric acid is part of the standard work-up of HTN in most guidelines.
Source: Guideline.gov, Medline