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Fludrocortisone therapy for persistent hyperkalaemia.

S J H Dobbin¹, J R Petrie¹, M E J Lean¹

¹Department of Diabetes and Endocrinology, Glasgow Royal Infirmary, Glasgow, UK.

Diabetic Medicine : a Journal of the British Diabetic Association

|April 5, 2017

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Fludrocortisone effectively treated recurrent hyperkalemia in a patient with Type 4 renal tubular acidosis and diabetes. This novel approach stabilized renal function when conventional methods failed, offering a new therapeutic option.

Area of Science:

Nephrology
Endocrinology
Internal Medicine

Background:

Type 4 renal tubular acidosis (RTA) is characterized by hyperkalemia, often linked to diabetes and specific medications.
Management of hyperkalemia in Type 4 RTA can be challenging, especially in patients with complex comorbidities.

Observation:

A 55-year-old woman with Type 2 diabetes and renal failure presented with recurrent hyperkalemia and deteriorating renal function.
Despite conventional treatments, her condition persisted, complicated by sepsis and poor venous access.
Fludrocortisone was initiated after 69 days of hospitalization, leading to stabilization of serum potassium and renal function.

Findings:

Following fludrocortisone administration, the patient's serum potassium normalized, and her estimated glomerular filtration rate (eGFR) improved.

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She was discharged and remained stable for over six months, demonstrating sustained efficacy of fludrocortisone.

This case highlights the potential of fludrocortisone in managing refractory hyperkalemia associated with Type 4 RTA.

Implications:

Fludrocortisone may represent a novel therapeutic strategy for difficult cases of Type 4 RTA with hyperkalemia.
Further research is warranted to explore the broader application of fludrocortisone in similar patient populations.
This case contributes to the limited evidence base for fludrocortisone use in this specific clinical context.