156) A 25 year old woman presents to your office with complaints of muscle cramps and weakness. On examination, she is afebrile, heart rate is 88/min and blood pressure is 150/98. Ophthalmoscopic examination shows the following :
Laboratory investigations reveal a Sodium of 144 meq/L, potassium of 3.0meq/L, Chloride 98meq/L , Bicarbonate of 34meq/L and Creatinine of 0.8mg%. Urinary chloride is 45meq/L. The most likely diagnosis that explains this patient’s clinical features :
A) Gitelman’s syndrome
B) Chronic Laxative abuse
C) Diuretic Abuse
D) Primary Hyperaldosteronism
E) Bartter’s syndrome
Ans D.
Most patients of bartter and gitelman syndrome have low or low-to-normal blood pressure. They may show signs of volume depletion.
D
ddd
D
Ophthalmoscopy- grade 2 hypertensive retinopathy
Labs- hypokalemic, metabolic alkalosis chloride resistant type( urine chloride >20 mEq/L)
A & E don’t cause hypertensive retinopathy
B causes metabolic acidosis
C causes chloride responsive type of Metab. Alkalosis ( urine chloride is < 10 mEq/L) initially high but low afterwards when it is depleted.
D hypertension, metabolic alkalosis, and chloride resistant type – yes chloride is reabsorped so it should be low but it become high in urine by pressue/ volume diuresis, phenomenon called aldosterone escape. ANSWER – D
Mistake, chronic laxative abuse typically causes metabolic alkalosis
Chronic laxative abuse causes metabolic acidosis or normal anion gap metabolic acidosis but both scenarios are chloride responsive type (urine chloride <10mEq/L) Answer is D, the only option that causes hypertension