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Course in the Ward

Course in the Ward. Day of Admission BP: elevated at 150/100mmHg Inability to move both lower extremities CBC ↓ WBC count (13,100/L) with normal neutrophil and lymphocyte values Serum electrolytes ↓ potassium (1.5mmol/L) and magnesium (0.65mmol/L) Slight ↑ in sodium (146mmol/L).

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Course in the Ward

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  1. Course in the Ward • Day of Admission • BP: elevated at 150/100mmHg • Inability to move both lower extremities • CBC • ↓ WBC count (13,100/L) with normal neutrophil and lymphocyte values • Serum electrolytes • ↓ potassium (1.5mmol/L) and magnesium (0.65mmol/L) • Slight ↑ in sodium (146mmol/L)

  2. Day of admission • Albumin, BUN and creatinine: normal • Urine electrolytes • ABG • ↑ pH (7.56) and HCO3 (28.7) • ↓ pCO2 • Lipid profile: normal • FBS: normal

  3. Day of admission • Uric acid: ↓ • Urinalysis • Few bacterial and epithelial cells • 25-30/hpf???? • CXR: clear • IV potassium chloride drip was started • Thyroid function test was requested

  4. Day 2-3 • BP : 160/100mmHg • Gradual improvement in strength • Movement of both legs from side to side • Gradual ↑ of potassium to 2.4mmol/L (day 3) • Thyroid function test: normal TSH and fT4 • Plan: saline suppression test when potassium level becomes normal

  5. Day 4-5 • Recovery of motor strength • Able to walk around the room without assist • Serum potassium: 4.7mmol/L • IV potassium  oral • Saline suppression test • Baseline plasma renin activity and aldosterone  2L IV saline infused over 4 hours  bplasma aldosterone

  6. Day 4-5 • BP : 200/100mmHg • spironolactone 25mg/tab, 1 tablet BID and felodipine10mg/tab, 1 tablet OD • Dicharged with plans for follow-up • Plasma renin and aldosterone results after 2 weeks

  7. Follow-up • BP maintained at 100-120/70-80mmHg • No recurrent weakness • Saline suppression test • ↑ baseline aldosterone: 12.69ng/dL • ↑ aldosterone post-infusion: 12.36ng/dL • ↓ plasma renin activitiy: <0.1ng/mL/hr

  8. Abdominal CT scan requested • Hypodense enhancing nodule, measuring 9.9 x 7.6 x 11.7mm, at the lateral limb of the left adrenal gland • Right adrenal gland unremarkable • No other abnormalities in the pre-contrast, arterial, portal venous and wash-out phases • Liver, pancreas and gallbladder are unremarkable • Referral to surgery

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