Laboratory results

Normal Value Results

Sodium 135-145 mEq/L 139 mEq/L
Creatinine 0.7-1.2 mg/dL 0.8 mg/dL
Hemoglobin 12.0-16.0 g/dl 14.1 g/dL
Potassium 3.6-4.8 mmol/L 4.2 mmol/L
bicarbonate 22-29 mEq/L 29 mEq/L
Calcium 9.5 mg/dL 8.9-10.1 mg/dL

Findings on electrocardiography were normal.

Health History
 Present health history of illness:
A woman presented to her local clinic for recurrent episodes of headache of several week’s
duration. Evaluation revealed a blood pressure of 172/100 mmHg. The patient was prescribed
37.5 mg of triamterene with 25 mg of hydrochlorothiazide (1 tablet) twice daily and 50 mg of
atenolol once daily. Her blood pressure remained elevated, and her headaches persisted. She
was referred to the hypertension clinic for further management.
 Past medical history:
The patient’s medical history was remarkable for preeclampsia during her her second pregnancy
9 years previously. She smoked half a pack of cigarettes per day for 15 years. Her alcohol use
was limited to social gatherings and consisted of 1 to 2 drinks monthly. She exercised regularly
and has a balanced low-salt diet. Essential hypertension was common on her maternal side.

Physical Assessment

General
On physical examination, the patient’s blood pressure was 172/100 mm Hg (both arms), and her heart
rate was 90 beats/min. Findings funduscopic examination were normal. Cardiac examination revealed a
grade 2/6 systolic ejection murmur at the right upper sternal border. Abdominal examination was
remarkable for a systolic-diastolic bruit present over the right midabdomen without palpable masses.
No evidence of pitting edema was observed, and findings on lung examination were normal.

Vital signs
BP: 172/100
T: 36.6
RR: 21
PR: 90
O2sat: 98