Hyporeninemic hypoaldosteronism in a affected person with diabetes mellitus: an unforgettable case report.
Int Med Case Rep J. 2018;11:69-72
Authors: Chelaghma N, Oyibo SO
A 58-year-old man introduced with a Three-year historical past of continual and intermittent hyperkalemia requiring recurrent attendances to the emergency division for pressing remedy. His medical historical past included secondary diabetes mellitus following a bout of acute pancreatitis and a earlier splenectomy for a spontaneous splenic rupture. He additionally had a historical past of extended use of non-steroidal anti-inflammatory medicine for again ache and painful neuropathy. He was not on any treatment or weight loss plan that might trigger a raised serum potassium degree and his renal perform was regular. He was on a basal-bolus insulin routine however his diabetes management had been poor for a number of years. Because the hyperkalemia had gone on for therefore lengthy within the presence of regular renal perform, he went on to have additional exams. Adrenal insufficiency had been dominated out following a brief Synacthen check. Additional investigations revealed low serum aldosterone ranges and inappropriately low serum renin ranges within the presence of hyperkalemia. This was suggestive of hyporeninemic hypoaldosteronism (HH). He was then handled with fludrocortisone and furosemide and his serum potassium ranges remained regular. Moreover, he didn’t require any extra emergency admissions to deal with hyperkalemia thereafter. It was concluded that the HH-induced hyperkalemia was attributable to diabetes mellitus or resulting from a mixture of diabetes and extended use of non-steroidal anti-inflammatory medicine. The absence of renal impairment might have contributed to the delay in prognosis. HH is a generally missed explanation for hyperkalemia. This case highlights the truth that it ought to all the time be suspected when unexplained hyperkalemia is present in sufferers with solely mild-moderately impaired renal perform, particularly within the presence of diabetes mellitus.
PMID: 29662328 [PubMed]