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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