Hydralazine/ondansetron/potassium

Abstract

Lack of efficacy: case report A 62-year-old man exhibited lack of efficacy during treatment with potassium, hydralazine and ondansetron [dosages not stated]. The man presented to the emergency department due to tingling and bilateral upper extremity numbness in the chest which radiated to the chin. His medical history was significant for carpel tunnel syndrome and benign prostate hyperplasia and hypertension. On admission, his serum potassium level was 2.2 mEq/L. He reported that he had been drinking radix glycyrrhizae [licorice] tea for the past 3–4 months. Recently, he was also drinking a new preparation of more concentrated radix glycyrrhizae tea. His medication history included omeprazole and alfuzosin. Following examinations, he was diagnosed with radix glycyrrhizaeinduced apparent mineralocorticoid excess. He was treated with large doses of IV potassium and unspecified phosphate supplementation for electrolyte repletion and IV hydralazine to control his BP. The following day, he developed persistent vomiting and nausea, which was uncontrolled with IV ondansetron. Then, metoclopramide and potassium fluids were added to the treatment regimen with resolution of symptoms the following day. At that time, he had persistent severe hypertension and hypokalaemia despite treatment with hydralazine and potassium. Therefore, he was admitted to the ICU. His sodium level remained normal throughout his hospital stay. After 3 days, his potassium level normalised to 3.7 mEq/L and BP reduced to 121/73mm Hg. He was advised to stop drinking radix glycyrrhizae tea and was discharged on potassium, spironolactone and hydralazine treatment. During his follow-up, his BP and potassium levels were stabilised, and his spironolactone, hydralazine and potassium were stopped.