A 50-year-old man with resistant hypertension has metabolic alkalosis (pH 7.48, HCO₃⁻ 34 mmol/L), hypokalaemia (K⁺ 2.9 mmol/L). Urine chloride is 45

Question

A 50-year-old man with resistant hypertension has metabolic alkalosis (pH 7.48, HCO₃⁻ 34 mmol/L), hypokalaemia (K⁺ 2.9 mmol/L). Urine chloride is 45 mmol/L. Aldosterone is elevated and renin is suppressed. He is not on any diuretics. What is the most likely cause?

Accepted Answer

Primary aldosteronism (chloride-resistant)

Answer

Bartter syndrome

Answer

Milk-alkali syndrome

Answer

NG suction/vomiting (chloride-responsive)

Answer

Diuretic use

Chloride-Resistant Metabolic Alkalosis — RACP Adult Medicine MCQ

A 50-year-old man with resistant hypertension has metabolic alkalosis (pH 7.48, HCO₃⁻ 34 mmol/L), hypokalaemia (K⁺ 2.9 mmol/L). Urine chloride is 45 mmol/L. Aldosterone is elevated and renin is suppressed. He is not on any diuretics. What is the most likely cause?