Uncontrolled HTN with low K+

Authors: V. Dimov, M.D., Cleveland Clinic; U. Tamhane, M.D.
Reviewer: S. Randhawa, M.D.

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:
Fundoscopy
CV and pulmonary exam
Abdominal exam for bruit
Peripheral pulses

What labs would you order?
BUN/Cr
Electrolytes
UA for RBC casts to r/o glomerulonephritis
EKG
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:
Hyperreninemic hyperaldosteronism

We have to find the cause...

References:

The renin-angiotensin system (RAS) or the renin-angiotensin-aldosterone system (RAAS). Click to enlarge the diagram.
Source: A. Rad. GNU Free Documentation License. Wikipedia.


Created: 03/2005
Updated: 03/05/2006