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dc.contributor.authorSaha, Arunava
dc.contributor.authorBalakrishnan, Suryanarayanan
dc.contributor.authorTrivedi, Nitin
dc.contributor.authorAbraham, George M
dc.date.accessioned2024-03-08T21:28:57Z
dc.date.available2024-03-08T21:28:57Z
dc.date.issued2022-10-21
dc.identifier.citationSaha A, Balakrishnan S, Trivedi N, Abraham GM. Hypertension and Severe Hypokalemia Associated With Oral Ingestion of Topical Hydrocortisone Cream. AACE Clin Case Rep. 2022 Oct 21;9(1):2-4. doi: 10.1016/j.aace.2022.10.004. PMID: 36654996; PMCID: PMC9837079.en_US
dc.identifier.eissn2376-0605
dc.identifier.doi10.1016/j.aace.2022.10.004en_US
dc.identifier.pmid36654996
dc.identifier.urihttp://hdl.handle.net/20.500.14038/53140
dc.description.abstractBackground: Topical use of corticosteroids causes systemic effects, but systemic toxicity by ingesting topical corticosteroid cream has not been reported. We describe a patient admitted with ingestion of over-the-counter (OTC) hydrocortisone cream. Case report: A 64-year-old woman presented with 2-weeks of generalized weakness. She had a history of hypertension, anxiety, depression, and chronic fatigue syndrome, but medical records were unavailable and she was not on any medications. She reported taking prednisone 7.5 mg daily for several years, which was discontinued 5 months ago. Due to worsening symptoms, she started ingesting OTC topical hydrocortisone as replacement and admitted to consuming 2 squirts of 1% hydrocortisone cream twice daily over the previous month leading up to hospitalization. Her pulse rate was 77/min, blood pressure was 232/110 mmHg. There was no pedal edema, elevated jugular venous pressure, hirsutism, muscle wasting, or purplish skin striae. Labs revealed potassium 1.5 mg/dL (3.6-5.4), serum cortisol 61.5 μg/dL (2.3-19.4), Creatine Kinase 1864 IU/L (24-173), undetectable adrenocorticotropic hormone. She received potassium, labetalol, and intravenous fluids. Her serum cortisol level decreased to 11 μg/dL and potassium to 4.1 mg/dL within 24 hours. She left the hospital against medical advice on Day 2. Discussion: Although both prednisone and hydrocortisone have glucocorticoid properties, only hydrocortisone has mineralocorticoid properties. Hydrocortisone 20 mg provides a mineralocorticoid effect equivalent to 0.1 mg fludrocortisone. Conclusion: Hydrocortisone cream was confirmed as the source of exogenous corticosteroid by an undetectable adrenocorticotropic hormone and rapid decrease in cortisol following discontinuation. Incorrect use of OTC medications can lead to life-threatening side effects.en_US
dc.language.isoenen_US
dc.relation.ispartofAACE Clinical Case Reportsen_US
dc.relation.urlhttps://doi.org/10.1016/j.aace.2022.10.004en_US
dc.rights© 2022 Published by Elsevier Inc. on behalf of the AACE. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/).en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectACTH, Adrenocorticotrophic hormoneen_US
dc.subjectFDA, Food and Drug Administrationen_US
dc.subjectOTC, Over-the-counteren_US
dc.subjecthypercortisolismen_US
dc.subjectingestionen_US
dc.subjectmineralocorticoid receptor activationen_US
dc.subjectover-the-counteren_US
dc.subjecttopical hydrocortisoneen_US
dc.titleHypertension and Severe Hypokalemia Associated With Oral Ingestion of Topical Hydrocortisone Creamen_US
dc.typeCase Reporten_US
dc.source.journaltitleAACE clinical case reports
dc.source.volume9
dc.source.issue1
dc.source.beginpage2
dc.source.endpage4
dc.source.countryUnited States
dc.identifier.journalAACE clinical case reports
refterms.dateFOA2024-03-08T21:28:59Z
dc.contributor.departmentMedicineen_US


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© 2022 Published by Elsevier Inc. on behalf of the AACE. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
Except where otherwise noted, this item's license is described as © 2022 Published by Elsevier Inc. on behalf of the AACE. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/).