indidoc1
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A 35-year-old woman with a history of insulin dependent diabetes mellitus comes to the clinic because she ‘feels ill’. She has no other medical issues and takes insulin NPH 20 units twice daily. She has no allergies. She does not smoke and denies alcohol or drug use.
A 35-year-old woman with a history of insulin dependent diabetes mellitus comes to the clinic because she ‘feels ill’. She has no other medical issues and takes insulin NPH 20 units twice daily. She has no allergies. She does not smoke and denies alcohol or drug use. Her blood pressure is 155/105 mm Hg and pulse is 80/min. Lung, heart, and abdomen examinations are normal. Laboratory studies show:
Her blood pressure is 155/105 mm Hg and pulse is 80/min. Lung, heart, and abdomen examinations are normal. Laboratory studies show:
A cortisol stimulation test is positive. After administration of 80 mg of furosemide and 3 hours of upright posture, her plasma renin and aldosterone levels are unchanged from baseline values. Which of the following is the most appropriate treatment?
A. Captopril
B. Fludrocortisone
C. Furosemide
D. Hydrocortisone
E. Potassium binders
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| indidoc1
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plz explain ur ans
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| indidoc1
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| tamerbashir
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Hydrocortisone
2nd adrenocortical insufficincy
( hyper kalemia +mild hyponatremia + but hypertension ??
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| indidoc1
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The correct answer is C. This patient has hyporeninemic hypoaldosteronism that occurs in adults with diabetes mellitus in the setting of mild renal failure, metabolic acidosis and hyperkalemia. The defect is the result of hyporeninism. Usually the aldosterone level rises after ACTH administration but not with postural changes. In this patient, the furosemide will treat the hyperkalemia and the acidosis.
Administration of captopril (choice A) will worsen the hyperkalemia.
Administration of fludrocortisone (choice B) which is a potent mineralocorticoid will help correct the electrolyte abnormality but should be avoided in patients with hypertension.
Administration of hydrocortisone (choice D) is not indicated since the patient is not adrenally insufficient.
Administration of potassium binders (choice E) can enhance potassium excretion but are likely to predispose the patient to total-body potassium deficits.
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| indidoc1
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i did not get the explanation fully 
anyone with a better expalanation?
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| drduck
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really didnt get this one.........
my answr after reading the question was fludrocortisone........
what is going on........
is endo so confusing????????
help
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| Ivonne
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This is a nice question. I was studying electrolytes when some question familiar came up.
Always think of Renal tubular acidosis(RTA) type 4 in diabetic patients with renal insufficiency and hyperkalemia and (non-anion gap metabolic acidosis------>in this case AG is 14.5...almost normal).
Anyways RTA type 4 may occur in the setting of diabetic nephropathy and it is caused by aldosterone deficiency or renal tubular insensitivity to aldosterone. The treatment is Furosemide, fludrocortisone(contraindicated in this case due to hypertension) and diet low in potassium. NEVER use ACEi or ARBs.
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