Hypertension With Hypokalemia: A Quiz.

A man in his mid-40s with a history of longstanding, untreated hypertension presented to the emergency department with right-sided neurologic deficits and slurred speech secondary to intracerebral hemorrhage discovered on computed tomography imaging. He was diagnosed with hypertension in his 20s, was not taking any antihypertensive medications, and did not have regular medical care. He did not use drugs, alcohol, or tobacco. Family history was pertinent for his father having hypertension and dying at age 56 years of myocardial infarction, a brother diagnosed with hypertension in his 20s, and his mother diagnosed with hypertension and diabetes. On admission, the patient’s blood pressure was 257/159 mm Hg, and he had hypokalemia (potassium level, 3.1 mmol/L), with preserved kidney function (serum creatinine level, 0.83 mg/dL). Bicarbonate level was 27 mmol/L. Coagulation values, lactate, and all other laboratory values were within reference ranges. Ethyl alcohol screening and urine toxicology findings were negative, and troponin test results were unremarkable. Table 1 includes the patient’s basic metabolic panel on