Re: Hospitalized with very high BP [1 Attachment]

[Guest guest]

One issue is are you salt depleted with the hot weather and the eplerenone?Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Did they stop or taper the metformin. You were on a lot as I recall.What other meds have been tired for DM?Has your weight been stable during all of this?How they take your BP when it was 230/130. Were you in pain or acutely ill?

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva wrote:

Hi Dr. Grim and the group,I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment. I also have images from MRI in case if Dr. Grim would like to take a look at them. Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure. I really don't know why it happened again and such high BP all of the sudden scares me to

death. The reasons that I consider:1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat. 3. Constant diarrhea over last two months since I overdosed metformin. 4. All the above together!?I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.Now I feel unstable and my BP varies from 110/65 to 160/100.

It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day. Many, many thanks. I would appreciate any responses. Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.

[Guest guest]

Yes your low urine sodium either means your are sodium depleted or doing the DASH very well.If you are not feeling well then more likely sodium depletion. If you were DASHing at 1500 mg Na and 4700 mg K would expect the urine K to be about 117 mM per 24 hr. So you may not be getting enough K or are K depleted as well. urine Na would be about 65 mM per 24 hr or in your case gm of creat as you put out exactly 1 gm creat on this day. REcommend slowly increasing Na intake to about 1500 mg of Na a day or more until you feel better or until BP increases.Check wt and BP every day if possible.

Clarence Grim MDlowerbp2@...

On Aug 3, 2012, at 2:46 PM, Natalia Kamneva wrote:

I just got the results of my 24 urine test, done on 07/27/2012: Total volume 2030 mLMICROALBUMIN, 24 HOUR URINE (W/CREAT) less than 0.2 mg/DlCreatinine 1.0 G/24 HR (0.63 - 2.50)POTASSIUM 87 MMOL/24 HR (20

-100)SODIUM 45 MMOL/G CREAT (50 -230)Also in attachment for a comparison with previous tests.Does low sodium confirms your sodium depletion hypothesis, Dr. Grim? Many, many thanks.Natalia From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 10:01 PM Subject: Re: Hospitalized with very high BP

I would try adding back a little salt each day to see if you feel any better. Especially if it has been very hot there.I would just add an increasing amount of sodium each day to see what happens. Keep K the same as you are on now.When some get very salt depleted the BP control system can fluctuate up and down.I would add about 1/4 teaspoon every 2 days and see what happens. Avoid big salt loads tho.Keep us posted.

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 6:08 PM, Natalia Kamneva wrote:

> One issue is are you salt depleted with the hot weather and the eplerenone?I assume that I am. When I eat a jar of marinated mushrooms (approximately 250 mg on Na), I feel immediately better. Should I eat more Na and less K?Does salt depletion cause spikes in blood pressure? >Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Seated 129/78, standing 123/78. HR is 115. >Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Yes, my BP fall a lot in a hospital and became worse at home. I was there and here on the same 100 mg dosage of eplerenone and 160 of micardis. They did 2 shots of BB when I arrived with 230/130. Next day my BP was still high, after that normal. > Did they stop or taper the metformin. You were on a lot as I recall.I was on 2000 mg until I overdosed it for three weeks to 4000mg. The endo stopped it completely. I am not on any diabetic medications right now. I was in insulin in the hospital.>What other meds have been tired for DM?I tried januvia in addition to metformin several years ago, but didn't see any positive effect. I was on glukophage when the insurance covered it. >Has your weight been stable during all of

this?Pretty much.> How they take your BP when it was 230/130. Were you in pain or acutely ill?I lay down. I was feeling terribly: shortness of breath, headache and all other symptoms of PA. Many thanks, Natalia Kamneva 68 F with 2.5 cm left adrenal adenoma, recently diagnosed with PA; diabetic; on 100 mg eplerenone, 40 mg Micardis, 2000 mg metformin, 60 mg Dexilant and 2 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim. From: Grim Clarence <lowerbp2@...> hyperaldosteronism Cc: Grim Clarence <lowerbp2@...> Sent: Wednesday, August 1, 2012 4:24 PM Subject: Re: Hospitalized with very high BP

One issue is are you salt depleted with the hot weather and the eplerenone?Recommend you take your BP seated and then stand for 1 min with arm supported so the cuff is at heart level and check the BP again. If is drops by more that 20 this suggests that you may be salt depelted and more salt may actually help.Did your BP fall a lot in the hospital as the numbers are if anything low on the record you sent but they may have loaded you up with BP meds.Did they stop or taper the metformin. You were on a lot as I recall.What other meds have been tired for DM?Has your weight been stable during all of this?How they take your BP when it was 230/130. Were you in pain or acutely ill?

Clarence Grim MDlowerbp2@...

On Aug 1, 2012, at 12:22 PM, Natalia Kamneva wrote:

Hi Dr. Grim and the group,I again was hospitalized with BP 230/130 and spent five days in the hospital. I don't have yet all medical records from the hospital, but I have Report from MRI without contrast and some blood test results. See the attachment. I also have images from MRI in case if Dr. Grim would like to take a look at them. Please, note, that my blood K was 5.0 and blood Na was 132, pretty much the same as it was a year ago when I was hospitalized with the same symptoms and a very high blood pressure. I really don't know why it happened

again and such high BP all of the sudden scares me to

death. The reasons that I consider:1. 4th of July picnic, where I ate much more salty food than usually. But after that I was on my dash for two weeks and felt pretty well.2. Summer heat. I was hospitalized five times for last two years and it always happened during summer heat. 3. Constant diarrhea over last two months since I overdosed metformin. 4. All the above together!?I am not on any diabetes medications now and my BS is really high, average fasting is 150-160. I also consider to change eplerenone to sipro, since eplerenone also causes diarrhea.Now I feel unstable and my BP varies from 110/65 to 160/100.

It's especially high at 8 am and 8 pm, when I also feel very badly. I am on higher dosage of eplerenone and micardis and Dashing very strictly, restricting Na < 700 - 800 mg a day. Many, many thanks. I would appreciate any responses. Natalia Kamneva 68 F with 3.5 cm left adrenal adenoma, diagnosed with PA in 2011; diabetic; on 100 mg eplerenone, 160 mg Micardis, currently not diabetic medication , 20 mg Omeprazol and 3 - 4 mg Lorazepam; Dashing; still have some occasional problems with BP, K and Na; on private consultation with Dr Grim.