Case Files 9 - Hypertension in Pregnancy, or was it?
Case submitted by Dr Jefrrey Lee on 15th Nov 2011
This is an extremely rare case. just would like to share it for academic purpose.
A 38 year old primigravida at 22 weeks POA was referred from MCH for stabilisation of severe hypertension in pregnancy
(BP=220/120 on 2 separate occasions).
No previous known history of hypertension but there is a family history of hypertension.
She is asymptomatic for preeclampsia, urine protein trace.
Routine PET workup taken shows that she is extremely hyperkalaemic (serum potassium =8.9).
Creatinine and other PET workup was normal and ECG does not show any changes suggestive of hyperkalaemia.
She was given cocktail, serum potassium improved to 4.5 but again increase to 7.8 a day later. - Sample was not lysed.
ABG was taken shows a compensating metabolic acidosis. She was otherwise asymptomatic with normal urine output.
The diagnosis is beyond our level as it is made by the Physician. But it is worthwhile to consider this when we cannot explain why a patient remain hypertensive, with asymptomatic hyperkalaemia and metabolic acidosis.
Ready for the diagnosis? --> Gordon's syndrome or type II pseudohypoaldosteronism. Nice to know, nice to forget too : )
This is an extremely rare case. just would like to share it for academic purpose.
A 38 year old primigravida at 22 weeks POA was referred from MCH for stabilisation of severe hypertension in pregnancy
(BP=220/120 on 2 separate occasions).
No previous known history of hypertension but there is a family history of hypertension.
She is asymptomatic for preeclampsia, urine protein trace.
Routine PET workup taken shows that she is extremely hyperkalaemic (serum potassium =8.9).
Creatinine and other PET workup was normal and ECG does not show any changes suggestive of hyperkalaemia.
She was given cocktail, serum potassium improved to 4.5 but again increase to 7.8 a day later. - Sample was not lysed.
ABG was taken shows a compensating metabolic acidosis. She was otherwise asymptomatic with normal urine output.
The diagnosis is beyond our level as it is made by the Physician. But it is worthwhile to consider this when we cannot explain why a patient remain hypertensive, with asymptomatic hyperkalaemia and metabolic acidosis.
Ready for the diagnosis? --> Gordon's syndrome or type II pseudohypoaldosteronism. Nice to know, nice to forget too : )
1 referrals:
this could really happen?
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