Primary aldosteronism diagnosis in the intensive care unit: resistant alkalosis and hypokalemia during severe sepsis with hyperlactatemia: a case report

Severe sepsis and septic shock in the intensive care unit typically present with metabolic acidosis. This case highlights an atypical presentation of paradoxical, resistant hypokalemia and alkalosis during severe sepsis, leading to a diagnosis of primary aldosteronism. Does the "inbuilt" tendency to metabolic alkalosis in primary aldosteronism confer survival advantage during intercurrent episodes of sepsis and metabolic acidosis? Given the high prevalence of renin-independent aldosterone production and benefits of mineralocorticoid receptor antagonists, universal primary aldosteronism screening for newly diagnosed hypertension appears meritorious and cost-effective.