Severe Hypertension Coexisting with Hypokalaemia in A Young Adult: Case Report and Literature Review

Abstract

Background: Systemic hypertension, affecting about one billion people worldwide, is the most prevalent modifiable risk factor for cardiovascular diseases and related disability. Secondary hypertension is a common problem among young adults. Case Summary: We report a case of a 23year old man who presented to the emergency room with 8-month history of progressive general body weakness preceded by numbness and paraesthesia initially involving the left then the right lower limbs with family history of hypertension. Blood Pressure was 150/80mmHg.His serum potassium was 1.6mmol/L (Normal range 3.0-5.0) other electrolytes, urea and creatinine were normal. Urinary potassium was 215mmol/24hr (Normal range < 20mmol/24hrs). A diagnosis of severe hypokalaemia in a hypertensive patient with Liddle’s syndrome was made. He was commenced on oral Moduretic (contains Amiloride and hydrochlorothiazide because Amiloride or triamterene only formulation is not available) and intravenous potassium replacement. Conclusion: Our index case is a 23year old young man known hypertensive who presented with quadriparesis and spontaneous hypokalaemia with family history of hypertension. The likely cause of his hypertension and hypokalaemia is Liddle’s syndrome, however plasma aldosterone concentration, plasma renin activity and genetic studies were not available for us to confirm this diagnosis. Even though this form of hypertension is rare, there is a need for a high index of suspicion for it by the clinicians whenever hypertension is diagnosed in a young individual especially in Maiduguri, Nigeria which have a high prevalence of renal impairment among young individuals’ majority of whom have background hypertension.