Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1230 Pruritus Pseudohypoaldosteronism

General Measures

■Emollients

■Topical antipruritic agents – menthol, pramoxine

➣Systemic antipruritic agents – soporific antihistamines such as

hydroxyzine, doxepin, cyproheptadine

specific therapy

■For localized pruritus – intralesional injection of triamcinolone

■For pruritus of hemodialysis, HIV, hepatic dysfunction – Ultraviolet

B phototherapy

■Treat underlying cause of the pruritus.

follow-up

During Rx

■Regularly assess potential complications of therapy; – irritation of

the skin or drowsiness from antihistamines

complications and prognosis

■Dependent upon the cause of the pruritus

PSEUDOHYPOALDOSTERONISM

MICHEL BAUM, MD

history & physical

■Pseudohypoaldosteronism type 1 (PHA) presents in the first week of

life with volume depletion, hyponatremia and hyperkalemia.

■Autosomal recessive PHA also has recurrent episodes of chest con-

gestion, coughing, and wheezing, not due to airway infections but

due to pulmonary fluid accumulation.

tests

■Both forms have hyponatremia due to renal salt wasting and hyper-

kalemia and elevated aldosterone levels; have type 4 renal tubular

acidosis.

differential diagnosis

■Autosomal recessive PHA is due to an inactivating mutation in the

epithelial sodium channel. It is typically much more severe and

presents earlier in life than the dominant form.

■Autosomal dominant PHA is due to inactivating mutations in the

aldosterone receptor.