adverse hypertension medication reaction

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i have a patient with a similar ethnic background, who had reticulohistiocytosis (a life-threatening reaction) due to HCTZ, happened before i ever saw her.if single medications fail to control his pressure, consider combinations including calcium channel blockers; i would stay away from beta blockers in such patients, they can have a diabetogenic effect.my similar background patient is reasonably well-controlled on amlodipine.if it's still a problem, consider doing a plasma renin, bnp and aldosterone, and consult a nephrologist, especially someone who has experience with patients of this ethnicity.do not fly by the seat of your pants alone on this one-- consider transfer to MMC in portland.hope that's helpful.LL wrote: so I have this guy I think he is 60 Looks much younger. sweet man. has a greenhouse. tries to grow citrus.( this is maine is he crazy But he is from t eh phillipines) difficult to control his htn I proceed endlessly through drugs one a t a time. I hate htn. it is so dreary... hctz made him peel. Red peely itchy ugh. I keep trying .All kinds of drugs one at a time .Increase the dose .Add or switch. Increase the dose etc Finally I give him hytrin. Bp is gorgeous he comes in and shows me he has been scratching his rt calf/ankle and it is red. Dx clearly cellultis . give him keflex. the other ankle had a few red macules I thought

nothing much of/ circualtion good seemed like run of the mill cellulits.Seen it a milllin times Comes back .skin is peeling and oozing Some edema . still moslty rt leg .left looks alittle crummy. arms and abd and thorax a littel dry and red and itchy Hmm allergy to kelfex?( non smoker no other dx) I place an unna boot see him back clean and re dress seems to be improving then i do not see him for 2 or 3 weeks Wife calls .cries worries goes on and on about skin peelingPatietn comes in. His legs are shiny oozing peeling and his feet are, as lay people say, black.He does not appear to see this. These were the blue-ist feet i have ever seen, on a living person. New grey hairs appear on my head. Shiny atrophic blue feet up to above ankles.sock level. augh . Good pulse left, none on rt. feet warm. oozing shiny skin to knees still some rash on hands rough red itchy, I stop all meds . I read up

on hytrin.Beats me. I do not thik it was teh antibx who knows.i order labs . sed rate 58.nl wbc hgb 11 lytes nl creatine 1.3 .i did not get a urine, vasc studies arterial and venous nl. he says he cannot sleep due to itch I give atarax and consider steroids I see him back in 2 days feet show evidence of pink but he is uncomfortable still the wife cries- they are getting divorced she is moving to calif to be near children he does not want to be near. she is leaving in one month why is so much skin peeling off she says over and over and over How should she dress it?( why is any of this happenein to me and how do I know?I think) I give steroids on Friday as he is uncomfortbale. Bp is still woderful. I say I need to see you on MOnday Today is monday he calls and says well maybe i will come in tomorow i am alot better .whew. so I guess he had vascultis/drug rxn? excuse me for publicly displaying any ignorance Damn now i will never get his bppp controlled. How do I know? Did i do all this for pretty cheap? yes.I do not know how much the vasc s tudies cost but boy was i glad tehy were normal i did not call in a specialist becasue I had no idea who to call anyways. Were the original leg lesions purpura? Is this a practiceimprovement story? See if you practiced WITH someone you might call them in.Was i supposed to know this was going to happen? Well. Just another day in paradise.

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