Correction of metabolic alkalosis by potassium chloride in ectopic adrenocorticotropic hormone syndrome.
A 57-year-old white man presented with metabolic alkalosis, hypokalemia (pH 7.58, HCO3 >50 mEq/L, serum K 1.8 mEq/L) and hypertension. The initial evaluation was significant for markedly elevated serum cortisol and adrenocorticotropic hormone (ACTH) level; neither hormone showed circadian rhythm or suppression with high-dose dexamethasone. Perihilar and supraclavicular masses were found to consist of undifferentiated small cell carcinoma. Ectopic ACTH syndrome was diagnosed. In spite of progressively rising hormone levels (ACTH, 723 pg/dL; and cortisol, 212 microgram/dL), his severe metabolic alkalosis was largely corrected by aggressive treatment with potassium chloride alone. Possible mechanisms of these clinical findings are discussed.
Islam
M
M
Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425-2220, USA.
Paul
R V
RV
D000182:ACTH Syndrome, Ectopic / Q000097:blood / Q000150:complications*; D000138:Acidosis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D018288:Carcinoma, Small Cell / Q000378:metabolism; D003907:Dexamethasone / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011189:Potassium Chloride / Q000627:therapeutic use*
D011189:Potassium Chloride; D003907:Dexamethasone; D011188:Potassium; D006854:Hydrocortisone