title: [Differential diagnostic dilemmas after use of an out-of-date antihypertensive medication. Case report].
abstract: Hydrochlorothiazide became one of the most commonly prescribed first-line antihypertensive medication, though its use is often complicated with serious side-effects. A 66-year-old female patient with a history of hypertension had suffered a transient loss of consciousness, and referred to our cardiology unit with an ST-segment elevation and giant negative T-waves in V1-2 ECG leads, long QT-segment and elevated serum creatine-kinase (5392 U/L) and troponin I (4,357 ng/ml) levels. Acute myocardial infarction was not proven (later coronarography revealed preserved coronary circulation), but severe hyponatraemia and hypokalaemia was detected, explaining a possible symptomatic seizure, and which could be accounted for a 25 mg daily hydrochlorothiazide antihypertensive treatment and - as a precipitating insult - a one-week history of gastroenteritis. The case-report presents a unique differential diagnostic question where thiazide-induced hyponatraemia and hypokalaemia resulted in a clinical picture sharing some similarities with acute myocardial infarction. This case underlines the serious side-effects of an inappropriately used common antihypertensive medication. Orv. Hetil., 2017, 158(11), 426-431.
authors.affiliation: Kardiológiai Osztály, Budai Irgalmasrendi Kórház Budapest, Árpád fejedelem útja 7., 1023.
authors.forename: Péter
authors.initials: P
authors.lastname: Arányi
authors.affiliation: Kardiológiai Osztály, Budai Irgalmasrendi Kórház Budapest, Árpád fejedelem útja 7., 1023.
authors.forename: János
authors.initials: J
authors.lastname: Tomcsányi
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000009:adverse effects*; D007008:Hypokalemia / Q000139:chemically induced* / Q000175:diagnosis*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis
chemical_list: D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide
keywords: ST elevation; ST-eleváció; hydrochlorothiazide; hydrochlorotiazid; hyponatraemia; thiazide-induced hyponatraemia; thiazides; tiazid indukálta hyponatraemia; tiazidok