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Life‐threatening hypokalaemia on a low‐carbohydrate diet associated with previously undiagnosed primary hypoaldosteronism
Author(s) -
Advani A.,
Taylor R.
Publication year - 2005
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2005.01714.x
Subject(s) - medicine , aldosterone , hyperaldosteronism , plasma renin activity , endocrinology , hypoaldosteronism , hypokalemia , diabetes mellitus , spironolactone , population , blood pressure , hyperkalemia , renin–angiotensin system , environmental health
Background Low‐carbohydrate diets are popular and fashionable for weight loss despite lack of evidence about long‐term effects. Many individuals attempting to lose weight have hypertension, especially those with diabetes, and the prevalence of hyperaldosteronism among hypertensive patients is higher than previously recognized. We present a patient with Type 2 diabetes and previously undiagnosed hyperaldosteronism who developed life‐threatening hypokalaemia while following a low‐carbohydrate diet. Case Report A 60‐year‐old man with diet‐treated Type 2 diabetes and hypertension presented with generalized muscle weakness and serum potassium of 1.9 mmol/l. He had succeeded in losing three and a half stones during the previous 4 months by adhering strictly to a low‐carbohydrate diet. HbA 1c was 4.8% and plasma aldosterone:renin ratios were elevated suggestive of increased aldosterone secretion. On a low‐calorie mixed diet serum potassium levels were maintained in the low‐normal range over the following 165 days. The adrenals were normal on CT scanning and blood pressure responded dramatically to the addition of spironolactone on day 212 (125/83 mmHg). Conclusions The prevalence of primary hyperaldosteronism in the hypertensive population, based on elevation of plasma renin:aldosterone ratio, is approximately 6%. The majority of these people are normokalaemic and remain undiagnosed. However, when carbohydrate intake is restricted such individuals are at increased risk of potentially life‐threatening metabolic derangements.