By Farahnak Assadi
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Additional info for Clinical decisions in pediatric nephrology: a problem-solving approach to clinical cases
Bartter’s syndrome Gitelman’s syndrome Diuretic abuse Primary hyperaldosteronism Secondary hyperaldosteronism Apparent mineralocorticoid excess Liddle’s syndrome The correct answer is D, E, F, and G. The presence of hypertension and mild metabolic alkalosis indicates that all causes of primary and secondary hyperaldosteronism, as well as Liddle’s syndrome and the various forms of apparent mineralocorticoid excess, have to be considered. BP would not be typically elevated with Bartter’s or Gitelman’s syndrome, but the abuse of diuretics in hypertensive patients should still be considered.
Rhabdomyolysis due to HAART-induced muscle toxicity B. Shift of K+ out of cells due to HAART-induced lactic acidosis 1 Fluid and Electrolyte Disorders 49 C. Blockade of distal renal tubule K excretion due to pentamidine D. Development of proximal RTA as a result of HAART therapy E. Addison’s disease due to adrenal HIV infection The correct answer is C. Pentamidine in the tubular lumen of the collecting duct competes for Na movement on the epithelial Na channel. The decrease in Na reabsorption decreases luminal electronegativity, thus decreasing the driving force for potassium secretion.
The length and severity of this condition increase with increasing age. The fellow assigned to the case was interested in the problem and was planning to present it at the next conference. Without your knowledge he had a plasma vasopressin level drawn. He now says to you that the vasopressin level was low, NOT high. He wants to know how that can be if the patient has hyponatremia and a concentrated urine. 26 Clinical Decisions in Pediatric Nephrology Your answer is which of the following? A. B.