HTN with frequent urinations

Looking for possible diagnosis from EMS call: 30 y/o female who presents conscious, semi alert and very anxious. Skin is cool and clammy. She complains of frequent urinations. She also appears young for her age. Vitals are BP 250/160, HR 140 and bounding (sinus tack on ECG), RR 28 with SaO2 at 98% on room air and BBS are clear. Pupils are PERRLA. All other vitals are within normal limits. History includes three hospital visits in the past three months for high blood pressure and each time sent home after  receiving

[CCF-M.D.-MJM]

Hi,

The best I can do is give you the differential diagnosis.  It is impossible to rank from most to least likely because of the absence of info on renal function, compliance, drug use, etc. Unfortunately you don't know if her baseline blood pressure is 140 and she flashes to 240 or if she is usually 200 and increases to 240.  

First, her acute diagnosis is hypertensive emergency (semi-alert suggests end organ damage --her brain).

1. fibromuscular displasia with renal artery stenosis
2. essential hypertension uncontrolled
3. illicit drug use (usually cocaine or crack)
4. pheochromocytoma -- it's almost never a pheo.
5. aldosterone secreting tumor
6. intrinsic renal disease/ renal failure (dialysis patients or near dialysis patients have some of the most difficult blood pressure to control)

those are some of the disease I would consider.  The reality is if you open a book on secondary hypertension, you will see close to 200 different causes.  Unfortuately the meat of the case is in what you do after she is stabilized and it take at least a few days turn up an answer -- probably longer.  That is unless her urine tox screen is positive.

I hope this is helpful.  Good luck

[Gaspipe]

Any HX of drug abuse?

[mom4cem]

Possibly pheochromocytoma? I'm assuming she has been checked for that already but that is what came to mind.

[Stelladallas]

I know that each time I've hadd AF, I have frequent urination.  I understood this was related to the rate.  Drug screen sure would'be helped one way or the other.  Stelladallas