title: Control of hyperkalemia with fludrocortisone in a patient with systemic lupus erythematosus.
abstract: We describe the use of fludrocortisone in a patient with systemic lupus erythematosus, who initially presented with moderate renal insufficiency, high serum potassium, metabolic acidosis, low urine pH, and a high urinary anion gap indicating tubular dysfunction. Renal histology revealed membranous glomerulonephritis and interstitial inflammation. During the course of the disease the patient developed persistent severe hyperkalemia. Dietary potassium restriction and therapy with diuretics combined with cation exchange resins failed to decrease potassium levels sufficiently. Drug therapy including cyclosporin A, enalapril, atenolol, phenytoin, necessary to control active disease and severe hypertension contributed to elevated potassium levels. Effective correction of hyperkalemia was achieved by fludrocortisone treatment. We conclude that fludrocortisone is a potent therapeutic approach for selected patients suffering from life threatening hyperkalemia, in whom potassium elevating drugs cannot be withdrawn.
authors.affiliation: Department of Medicine, University Hospital of Freiburg, FRG.
authors.forename: K W
authors.initials: KW
authors.lastname: Dreyling
authors.forename: C
authors.initials: C
authors.lastname: Wanner
authors.forename: P
authors.initials: P
authors.lastname: Schollmeyer
mesh_terms: D000293:Adolescent; D001262:Atenolol / Q000009:adverse effects; D003404:Creatinine / Q000652:urine; D003524:Cyclosporins / Q000009:adverse effects; D004656:Enalapril / Q000009:adverse effects; D005438:Fludrocortisone / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008297:Male; D010672:Phenytoin / Q000009:adverse effects; D011188:Potassium / Q000378:metabolism; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D003524:Cyclosporins; D001262:Atenolol; D010672:Phenytoin; D004656:Enalapril; D003404:Creatinine; D011188:Potassium; D005438:Fludrocortisone