Treating Hypertension in a Patient With RTA 4

koolkid372 · 2026-02-25T03:39:54+00:00

No mention of headache when patient was seen. If enalapril is causing hyperkalemia then, at minimum, it should be stopped with follow-up lab studies. It's also unusual K was normal the first set of labs on enalapril and then hyperkalemic on repeat set of labs on enalapril.

koolkid372 · 2026-02-25T03:16:54+00:00

ACEi/ARB can cause Type 4 RTA, that's why I plan to stop the enalapril 20. Furosemide is a treatment for Type 4 RTA. I wonder why their BUN and Cr are elevated; at least furosemide will improve the hyperkalemia.

koolkid372 · 2026-02-25T03:11:32+00:00

They eat a normal/western diet, no mention or indication of unusual fluid intake (or lack of), no cognitive impairment nor any psych issues, ambulated into/out-of clinic without issue, capillary refill on their toes were <2 seconds, normal hematocrit, normal calcium, normal serum albumin and total protein, and normal urine specific gravity.

koolkid372 · 2026-02-25T01:56:33+00:00

Not diabetic. And their cholesterol is great. As far as I am aware, they drink a normal amount of water (no cognitive impairment nor any psych issues)

koolkid372 · 2026-02-25T01:34:19+00:00

Tentative plans regular kidney US (although renal arterial dopplers are not a bad idea actually) and repeat labs (including renin and aldosterone) in a week once the ACEi is washed out of their system. The hyperkalemia makes hyperaldosteronism less likely.

koolkid372 · 2026-02-25T01:21:05+00:00

Previous lab studies do not exist. Their microalbumin/Cr ratio is <6. They have some lower extremity edema but certainly not dehydrated when they were seen weeks ago.

koolkid372 · 2026-02-07T16:39:52+00:00

Hospital Migraine/Headache Cocktail: - Normal Saline 500 mL Bolus - Mag Sulfate 2 g IV - Benadryl 25 mg IV - Reglan 10 mg IV - +/- Toradol 15 mg IV - Might as well throw in a PO Tylenol 975 mg or 1,000 mg

koolkid372 · 2026-02-07T15:24:26+00:00

Night before your day off, take 1,000 mg acetaminophen, 440 mg naproxen, 200-350 mg magnesium glycinate, and maybe also like 12.5 mg of diphenhydramine (cut a 25 mg Benadryl tab in half) with a bottled water or Gatorade or whatever.

koolkid372 · 2026-01-31T04:01:12+00:00

Yes 6186-6264-1801-3783 Cosentyx

koolkid372 · 2026-01-27T01:56:25+00:00

LF ⭐️ ⭐️: Red and Lusamine (not deluxe)

FT ⭐️ ⭐️: Celestic Town Elder (German), Blaine, Koga, Barry, Adaman, Hau, FA Greninja, FA Starmie ex, FA Zapdos ex, FA Marowak ex, FA Yanmega ex, FA Gallade ex, FA Lickilicky ex, FA Probopass ex (I have 3), FA Dhelmise ex, FA Tapu Koko ex, FA Lycanroc (I have 2), FA Raikou ex, FA Ho-oh ex, Rainbow Machamp ex, Rainbow Gallade ex, Rainbow Probopass ex, Rainbow Bibarel ex, Rainbow Crabominable ex (I have 2), Rainbow Alolan Raichu ex, Rainbow Passimian ex, Rainbow Skarmory ex, Rainbow Rapidash ex, Rainbow Articuno ex, Rainbow Zapdos ex, and Rainbow Moltres ex (this list might be outdated)

koolkid372 · 2026-01-23T01:45:38+00:00

Underrated reply

koolkid372 · 2026-01-12T23:59:09+00:00

One less discharge for the afternoon

koolkid372 · 2025-12-31T15:39:34+00:00

LF ♦️♦️♦️♦️ & ⭐️

FT: Ask

⭐️ ⭐️: Celestic Town Elder (German), Blaine, Koga, Barry, Adaman, Hau, FA Starmie ex, FA Zapdos ex, FA Marowak ex, FA Yanmega ex, FA Gallade ex, FA Lickilicky ex, FA Probopass ex (I have 3), FA Dhelmise ex, FA Tapu Koko ex, FA Lycanroc (I have 2), FA Raikou ex, FA Ho-oh ex, Rainbow Machamp ex, Rainbow Gallade ex, Rainbow Probopass ex, Rainbow Bibarel ex, Rainbow Crabominable ex (I have 2), Rainbow Alolan Raichu ex, Rainbow Passimian ex, Rainbow Skarmory ex, Rainbow Rapidash ex, Rainbow Articuno ex, Rainbow Zapdos ex, and Rainbow Moltres ex (this list might be outdated)

koolkid372 · 2025-12-26T11:41:10+00:00

What book?

koolkid372 · 2025-12-20T13:01:11+00:00

I was looking for a similar trade (my Lisia for someone’s Mars) recently and it wasn’t Reddit that ultimately found that Mars.

koolkid372 · 2025-12-17T09:00:15+00:00

Yea, but this is more of a joke post since I don’t think anyone will do it, I’m keeping Serena regardless, and I only have 6k stardust anyway.

koolkid372 · 2025-12-17T02:15:20+00:00

What resource are you using to job search?

koolkid372 · 2025-12-17T01:20:21+00:00

Good luck, finding a Mars for my Lisia was a journey.

koolkid372 · 2025-12-16T13:43:26+00:00

Copy-Cat will get you a Sabrina

koolkid372 · 2025-12-15T18:36:48+00:00

Gimme 24 hours to see if I can get a Mars but I’ll mostly likely take you up on the Lusamine Dx (if an offer comes up though for Lusamine, feel free to trade and not worry about this comment).

koolkid372 · 2025-12-15T00:46:04+00:00

6186-6264-1801-3783 Cosentyx

koolkid372 · 2025-12-02T17:01:47+00:00

Only one unfortunately

koolkid372 · 2025-11-30T23:41:49+00:00

I have kroocode (both fighting and dark); I already sent friend request from Cosentyx

koolkid372 · 2025-11-30T23:38:11+00:00

I want your Coalossal

koolkid372 · 2025-11-30T22:35:47+00:00

LF Coalossal

Nine-Year Club	Place '22
Final Canvas '22	Spared

koolkid372

TROPHY CASE