Date sent: Tue, 15 Apr 2003 18:01:09 +0100
Send reply to: Reza Morovat <[log in to unmask]>
From: Reza Morovat <[log in to unmask]>
Subject: Re: THE DIAGNOSIS OF PRIMARY HYPERALDOSTERONISM
To: [log in to unmask]
If I recall correctly, the SAS lab in Leeds has withdrawn urine
aldosterone because of its poor predictive values.
>
> As you know, primary hyperaldosteronists are usually already sodium
> over-loaded (though chloride depleted). I think your clinician might
> realise the importance of recording increased compound x in a situation
> where it's supposed to be low, i.e. high aldostron/renin in the absence of
> volume- or salt-depletion. But sometimes, maybe too often, things are
> planned without due thought and to extreme, e.g. we've all asked about
> water-deprivation in a severely volume-depleted individual or acid-load
> test in an already-acidotic! I wonder whether, rather than giving NaCl, a
> frusamide test wouldn't be better. If your clinician's idea is to
> replenish chloride (e.g. to assess whether the metabolic alkalosis that the
> patient has is chloride-responsive) that's a different matter and a urinary
> chloride may help.
>
> May I take the opportunity to ask another one of my silly questions
> please? In metabolic acidosis when bicarb is given, it decreases H+ but it
> also increases CO2. CO2 traverses the blood-brain barrier easier than
> bicarb and exacerbates central acidosis. One alternative would be to give
> another base instead, e.g. tris. Is this ever practised?
>
> Thanks,
>
> Reza Morovat
>
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