A 35-year-old female with a history of poorly controlled hypertension presents with paraesthesia and weakness. Her blood results are shown below:

Parameter

Patient Value

Normal Adult Range

Sodium

145 mmol/L

135 – 145

Potassium

1.8 mmol/L*

3.5 – 5.0

Chloride

85 mmol/L*

95 – 105

Bicarbonate

40 mmol/L*

24 – 32

Urea

3.4 mmol/L

3.0 – 8.5

Creatinine

80 micromol/L

70 – 110

Parameter

Patient Value

Normal Adult Range

pH

7.56*

7.35 – 7.45

pO2

85 mmHg (11.3 kPa)

pCO2

46 mmHg* (6.1 kPa)*

35 – 45 mmHg (4.6 – 5.9 kPa)

Bicarbonate

40 mmol/L*

24 – 32

FiO2

0.21

a) Interpret these results.
 
b) List two likely diagnoses.
 
c) Give two drugs used to treat this condition.

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College Answer

a)
Metabolic alkalosis with partial respiratory compensation and severe hypokalaemia.

b)
 Primary Hyperaldosteronism most likely secondary to an aldosterone producing adenoma (Conn's syndrome – 50 – 60%) or adrenal hyperplasia (40 – 50%).
 Licorice ingestion.
 Liddle's syndrome.
 Excessive diuretic use.

c)
 Aldosterone antagonist (spirinolactone or eplerenone).
 Amiloride.

Discussion

This question is identical to Question 18.2 from the first paper of 2011.