Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension: a case report.
BACKGROUND
The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children.


METHODS
An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3-11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described.


CONCLUSIONS
As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness.
Dixit
Mehul P
MP
Steele Memorial Children's Research Center, Department of Pediatrics, University of Arizona, Tucson, USA. mdixit@peds.arizona.edu
Hughes
John D
JD
Theodorou
Andreas
A
Dixit
Naznin M
NM
D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D006801:Humans; D006974:Hypertension, Malignant / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006978:Hypertension, Renovascular / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D007010:Hyponatremia / Q000150:complications*; D007223:Infant; D007741:Labetalol / Q000627:therapeutic use; D008297:Male
D000959:Antihypertensive Agents; D000450:Aldosterone; D003404:Creatinine; D007741:Labetalol