A man in his sixties with severe hypotension and oedema.

A man in his sixties was admitted to hospital late one evening after fainting in the bathroom. He had felt increasingly lethargic in the days immediately prior to hospitalisation, but had not otherwise noticed anything out of the ordinary. He had been treated for hypertension for the past 10 – 12 years, initially with amlodipine (Norvasc), subsequently with carvediol, irbesartan/hydrochlorothiazide (CoAprovel) and moxonidine (Physiotens). In addition he used Albyl-E 75 mg  1. He was otherwise in good physical shape apart from sequelae in the form of bilateral drop foot following previous severe ischaemia in the lower extremities. In Acute Admissions he had transient bradycardia and his blood pressure dropped. The lowest blood pressure reading was 64/27. At the same time he was lethargic, clammy and pale. After infusion of intravenous fluid (NaCl 0.9 %), he picked up and was in such good shape that he was placed in an ordinary ward. His pulse was 70, blood pressure 109/ 64 and his temperature 37.9°C. He remained conscious and lucid, and the findings from his admission examination were otherwise normal.