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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Nephrology

Symptoms, Warning Signs & Emergencies

At a Glance

With apparent mineralocorticoid excess, excessive thirst, frequent urination, poor growth, and fatigue may be ongoing symptoms, but sudden weakness, fainting, abnormal heartbeat, breathing trouble, neurologic changes, vision loss, or chest pain require urgent or emergency care.

While Apparent Mineralocorticoid Excess (AME) is a chronic condition that you will manage daily, it can sometimes lead to acute situations that require immediate medical attention. Because AME affects the two most critical regulators of your or your child’s cardiovascular health—blood pressure and potassium—it is essential to know which symptoms are part of the “new normal” and which require a trip to the hospital [1][2].

Common Symptoms: The “New Normal”

Many patients with AME live with daily symptoms that reflect the ongoing challenge of managing the condition. These are signs that the “salt-saving” switch in the kidney is stuck in the “on” position [3].

  • Polyuria and Polydipsia: You or your child may drink excessive amounts of water and urinate very frequently [3][4].
  • Poor Weight Gain: Children may not gain weight or grow as fast as their peers, often termed failure to thrive [5][4].
  • Mild Fatigue: Chronic low potassium can make a person feel more tired or lethargic than usual [6].

When to Call Emergency Services (911)

Certain symptoms indicate that the body is no longer able to compensate for high blood pressure or low potassium. These are medical emergencies. Do not delay emergency care for any of the following symptoms.

Hypertensive Emergency

A hypertensive emergency isn’t defined by a single “magic number” on the blood pressure cuff, but rather by whether the high pressure is causing end-organ damage—meaning it is affecting the brain, heart, or eyes [7][8].

  • Neurologic Changes: Seizures, sudden confusion, altered consciousness, or a sudden weakness or “droop” in the face or limbs [9][10][11].
  • Vision Loss or Changes: Sudden blurring or loss of vision, which can be a sign of hypertensive retinopathy [12].
  • Cardiac Distress: Severe chest pain, extreme shortness of breath, or a sudden cough with bubbly spit (signs of fluid in the lungs) [13][10].

Severe Hypokalemic Emergency

When potassium levels drop dangerously low, the electrical system of the heart and the strength of the muscles are at immediate risk. Serious arrhythmias can occur at varying levels depending on the individual, so symptoms matter more than waiting for a specific threshold [14][15].

  • Flaccid Paralysis: Sudden, severe muscle weakness where you become “limp” or unable to move arms or legs [16][17].
  • Arrhythmias: A feeling of the heart “skipping beats,” “racing,” or fainting/passing out suddenly. This may be due to dangerous electrical changes seen on an ECG [18][19].
  • Breathing Difficulty: Severe weakness can occasionally affect the muscles used for breathing.

Same-Day Urgent Care

Contact your specialist today (do not wait for the next scheduled appointment) if you experience:

  • A blood pressure reading significantly higher than the “target range” provided by your doctor [7].
  • A new and worsening headache [15].
  • Vomiting or diarrhea that prevents you from taking and keeping down your prescribed potassium supplements.
  • Sudden increases in thirst, urination, or new muscle twitching/cramping.

What You Must Never Do

  • Never self-adjust potassium: Giving extra potassium without clinician instruction can cause life-threatening hyperkalemia.
  • Never change medication doses independently: Even if you suspect symptoms are due to low potassium or high blood pressure, consult your care team before altering the treatment plan.

Note: Always follow the specific, written “Action Plan” provided by your nephrologist or endocrinologist, which should include personalized thresholds and contact instructions for during and after office hours.

Common questions in this guide

What symptoms are common with apparent mineralocorticoid excess?
Common symptoms include excessive thirst, frequent urination, poor weight gain or slower growth in children, and mild fatigue. These symptoms can reflect the ongoing effects of high blood pressure or low potassium, while new or worsening symptoms should be discussed with the care team.
When should I call emergency services for AME?
Call emergency services for seizures, sudden confusion, fainting, new weakness or facial drooping, sudden vision loss, severe chest pain, extreme shortness of breath, or sudden severe muscle weakness. A racing or irregular heartbeat, inability to move, or breathing difficulty also needs immediate evaluation.
What are signs of dangerously low potassium in AME?
Warning signs include sudden severe weakness, limp muscles, trouble moving the arms or legs, a racing or irregular heartbeat, fainting, or difficulty breathing. These symptoms can signal dangerous changes in heart rhythm or breathing and require emergency care.
What should I do if my child vomits and cannot keep down potassium?
Contact your child’s specialist the same day for instructions because vomiting can prevent the prescribed supplement from working. If there is fainting, severe weakness, a racing or irregular heartbeat, breathing difficulty, or another emergency symptom, call emergency services rather than waiting.
Can I give extra potassium or change AME medication on my own?
No. Do not give extra potassium or change medication doses unless your clinician tells you to, because too much potassium or an incorrect dose can be dangerous. Use the written action plan from your nephrologist or endocrinologist.
What blood pressure reading is an emergency for a child with AME?
There is no single emergency number that applies to every child; the threshold depends on age, height, usual readings, and whether there are signs of organ damage. Ask the treating specialist for a personalized crisis threshold and seek emergency care for neurologic changes, vision loss, chest pain, or severe breathing problems.

Get notified when new evidence is published on Apparent mineralocorticoid excess.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

References

References (19)
  1. 1

    Apparent mineralocorticoid excess in Israel: a case series and literature review.

    Lebel A, Ben Shalom E, Mokatern R, et al.

    European journal of endocrinology 2024; (190(5)):347-353 doi:10.1093/ejendo/lvae049.

    PMID: 38652803
  2. 2

    Apparent mineralocorticoid excess.

    Funder JW

    The Journal of steroid biochemistry and molecular biology 2017; (165(Pt A)):151-153 doi:10.1016/j.jsbmb.2016.03.010.

    PMID: 26956190
  3. 3

    Apparent mineralocorticoid excess mimicking Bartter syndrome in infancy.

    Hatipoğlu S, Yıldırım E, Şalbaş ÖY, et al.

    Journal of pediatric endocrinology & metabolism : JPEM 2026; doi:10.1515/jpem-2026-0333.

    PMID: 42912472
  4. 4

    Apparent mineralocorticoid excess with a novel HSD11B2 variant: longitudinal clinical and biochemical follow-Up.

    Nalluri BT, Kudugunti N, Sahay RK

    JCEM case reports 2026; (4(6)):luag083 doi:10.1210/jcemcr/luag083.

    PMID: 42064719
  5. 5

    A Rare Case of Apparent Mineralocorticoid Excess Presenting as Endocrine Hypertension.

    Vijayakumar V, Kumar N, Kumar D, et al.

    Indian journal of nephrology 2025; (35(3)):427-428 doi:10.25259/IJN_83_2024.

    PMID: 40352883
  6. 6

    Clinical, genetic, and structural basis of apparent mineralocorticoid excess due to 11β-hydroxysteroid dehydrogenase type 2 deficiency.

    Yau M, Haider S, Khattab A, et al.

    Proceedings of the National Academy of Sciences of the United States of America 2017; (114(52)):E11248-E11256 doi:10.1073/pnas.1716621115.

    PMID: 29229831
  7. 7

    Hypertensive crisis in children and adolescents.

    Seeman T, Hamdani G, Mitsnefes M

    Pediatric nephrology (Berlin, Germany) 2019; (34(12)):2523-2537 doi:10.1007/s00467-018-4092-2.

    PMID: 30276533
  8. 8

    Hypertensive Crisis in Pediatric Patients: An Overview.

    Raina R, Mahajan Z, Sharma A, et al.

    Frontiers in pediatrics 2020; (8()):588911 doi:10.3389/fped.2020.588911.

    PMID: 33194923
  9. 9

    Hypertension crisis as the first symptom of renovascular hypertension in children.

    Xu L, Ba H, Jiang X, Qin Y

    Italian journal of pediatrics 2022; (48(1)):191 doi:10.1186/s13052-022-01378-4.

    PMID: 36461036
  10. 10

    Clinical Characteristics of Hospitalized Pediatric Patients With Hypertensive Crisis-A Retrospective, Single-Center Study in China.

    Ba H, Peng H, Xu L, et al.

    Frontiers in cardiovascular medicine 2022; (9()):891804 doi:10.3389/fcvm.2022.891804.

    PMID: 35711370
  11. 11

    Impaired Distal Tubular Acidification, Renal Cysts and Nephrocalcinosis in Monogenic Hypertension.

    Yadav M, Sinha A, Hari P, Bagga A

    Indian journal of pediatrics 2021; (88(6)):579-581 doi:10.1007/s12098-020-03516-4.

    PMID: 33236328
  12. 12

    Reversible posterior encephalopathy syndrome in a 10-year-old child.

    Carvalho EG, Peluso HGC, Batista LL, et al.

    Jornal brasileiro de nefrologia 2019; (41(3)):436-439 doi:10.1590/2175-8239-JBN-2018-0111.

    PMID: 30281063
  13. 13

    Profile and management of hypertensive urgencies and emergencies in the emergency cardiology department of a tertiary hospital: a 12-month registry.

    Fragoulis C, Dimitriadis K, Siafi E, et al.

    European journal of preventive cardiology 2022; (29(1)):194-201 doi:10.1093/eurjpc/zwab159.

    PMID: 34718521
  14. 14

    Clinical phenotypes and genetic analysis of 30 children with Gitelman syndrome.

    Wang W, Zhao F, Ding G, et al.

    Frontiers in pediatrics 2026; (14()):1853435 doi:10.3389/fped.2026.1853435.

    PMID: 42416094
  15. 15

    Potassium Disorders: Hypokalemia and Hyperkalemia.

    Viera AJ, Wouk N

    American family physician 2015; (92(6)):487-95.

    PMID: 26371733
  16. 16

    Hypokalemia-Induced Rhabdomyolysis Following Prolonged Diarrhea in a Child With Congenital Heart Disease Receiving Loop Diuretics: A Case Report and Literature Review.

    Iwasaki K, Akiyoshi M, Nakashima S, et al.

    Cureus 2026; (18(2)):e104451 doi:10.7759/cureus.104451.

    PMID: 41918674
  17. 17

    Hypertensive Crisis with Neurological Impairment Mimicking a Guillain-Barrè Syndrome: Searching for a Link.

    Mazza A, Lucchetta M, Torin G, et al.

    High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension 2018; (25(4)):421-424 doi:10.1007/s40292-018-0283-y.

    PMID: 30298226
  18. 18

    Hypokalemia-Induced Arrhythmia: A Case Series and Literature Review.

    Thu Kyaw M, Maung ZM

    Cureus 2022; (14(3)):e22940 doi:10.7759/cureus.22940.

    PMID: 35411269
  19. 19

    Lower-Extremity Weakness in a Teenager Due to Thyrotoxic Periodic Paralysis.

    Thornton MD

    The Journal of emergency medicine 2017; (52(4)):e133-e137 doi:10.1016/j.jemermed.2016.11.006.

    PMID: 27955984

This page is for informational purposes only and does not constitute medical advice. Follow your nephrologist’s or endocrinologist’s personalized action plan for apparent mineralocorticoid excess and seek emergency care for severe symptoms.

Guide contents Apparent mineralocorticoid excess
Research & Literature
02 The Biology and Diagnosis of AME 04 Treatment and Day-to-Day Management