Subclinical PA was defined by stage 1 hypertension with serum potassium greater than 3 mEq/L or normokalemia
(serum potassium > 3.5 mEq/L).
However, hyperaldosteronism may also present with normokalemia
, especially in the early phase of the disease, and after taking potassium-wasting diuretics, hypokalemia occurs, as seen in this case.
To analyze proportions of subjects with altered serum [[Na.sup.+]], [[K.sup.+]], and osmolality levels during mannitol administration, subjects were divided into groups (hypernatremia, normonatremia, and hyponatremia), defined as follows: hypernatremia, [[Na.sup.+]] > 145 mEq/L; normonatremia, 135 mEq/L [less than or equal to] [[Na.sup.+]] [less than or equal to] 145 mEq/L; hyponatremia, [[Na.sup.+]] < 135 mEq/L; hyperkalemia, [[K.sup.+]] > 5.5 mEq/L; normokalemia
, 3.5 mEq/L [less than or equal to] [[K.sup.+]] [less than or equal to] 5.5 mEq/L; hypokalemia, [[K.sup.+]] < 3.5 mEq/L; hyperosmolality, osmolality > 295 mOsm/kg; normoosmolality, 285 mOsm/kg [less than or equal to] osmolality [less than or equal to] 295 mOsm/kg; and hypo-osmolality, osmolality < 285 mOsm/kg.
The combination of the two drugs, which are started together to begin treatment, is the most effective regimen of diuretics, initiated in a ratio of 100:40, to maintain normokalemia
(Runyon, 2004; Sandhu & Sanyal, 2005; Schouten & Michielsen, 2007).
Some of these subtypes may have normal potassium concentrations; therefore, normokalemia
does not exclude the diagnosis of primary aldosteronism (27, 28).
After achieving liberal sodium intake and normokalemia
, plasma aldosterone and renin activities were measured.
Female sex and hypokalemia (< 3.5 mmol/l) was associated with a relative risk of 4.53 for severe QT prolongation as compared with normokalemia
, while the relative risk associated with female sex was 4.45 as compared with male sex.