title: Saline-resistant metabolic alkalosis, severe hypokalemia and hypertension in a 74-year-old woman.
abstract: The case of a 74-year-old woman with past history of hypertension and cerebrovascular accident admitted with pneumonia, dehydration, hypernatremia and severe hypokalemic alkalosis is presented. After correction of the hypertonic dehydration, the hypokalemia and alkalosis persisted in spite of aggressive potassium supplementation and the patient became hypertensive. Mineralocorticoid excess was suspected and excluded after extensive endocrinological testing. The use of aldactone failed to revert the abnormalities. Triamterene administration corrected the electrolytes and acid base aberrations, and dramatically improved the blood pressure control. This clinical picture is compatible with the diagnosis of Liddle's syndrome. Our patient exemplifies the unique occurrence of hypokalemic metabolic alkalosis in association with volume contraction at the start of the hospitalization and volume expansion later on her course.
authors.affiliation: Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY 11203, USA.
authors.forename: L
authors.initials: L
authors.lastname: Rezkalla
authors.forename: S
authors.initials: S
authors.lastname: Borra
mesh_terms: D000368:Aged; D000471:Alkalosis / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D007008:Hypokalemia / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D014223:Triamterene / Q000627:therapeutic use*
chemical_list: D004232:Diuretics; D014223:Triamterene