FUROSEMIDE AND DDAVP FOR THE TREATMENT OF PSEUDOHYPOALDOSTERONISM TYPE-II

A 27-year-old Turkish male presented with fatigue, long lasting hypert ension, hyperkalemia, hyperchloremic metabolic acidosis and normal glo merular filtration rate. His brother also showed hyperkalemia with no other features of the disease. Plasma renin levels were low and serum aldosterone levels were inappropriately low-normal to his hyperkalemia . Plasma cortisol levels were normal. Plasma renin aldosterone levels responded appropriately to postural changes, salt restriction and sali ne infusion. Fludrocortisone was ineffective in his hyperkalemia. The conditions were consistent with Type II pseudohypoaldosteronism (PHA). Furosemide and sodium bicarbonate were effective to control his hyper chloremia, metabolic acidosis and hypertension but partly effective fo r his hyperkalemia. dDAVP alone did not control the situation and hype rtension and metabolic derangement reoccurred. Adding dDAVP to furosem ide and sodium bicarbonate successfully controlled hyperkalemia, hyper chloremic acidosis and hypertension. The patient stayed normotensive w ith normal metabolic and biochemical parameters after 6 months with fu rosemide and dADVP although sodium bicarbonate had been discontinued a fter the first month of therapy. dDAVP is a useful adjunct to furosemi de and non chloride anions which altogether successfully reverse the m etabolic derangement in Type II PHA. (C) 1997, Editrice Kurtis.