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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of hyperkalemia

  • List the common etiologies of hyperkalemia

  • Identify the goals of therapy for hyperkalemia

  • Develop an appropriate treatment and monitoring plan for hyperkalemia on the basis of individual patient characteristics

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PATIENT PRESENTATION

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Chief Complaint

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N/V, and associated weakness persisting for 4 days

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History of Present Illness

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DS is a 53-year-old Caucasian male who was brought to the emergency department (ED) via ambulance. The patient was unable to provide an in-depth history, but the patient's family noted that he had been experiencing episodes of N/V/D with associated weakness for approximately 4 days. He began feeling worse yesterday morning and had some increased sleepiness. This morning he was nearly unresponsive, so 911 was called. Upon arrival to the ED, the patient was sleepy but arousable, oriented to person and place, with significant bradycardia and hypotension. An ECG done in the ED showed atrial fibrillation.

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Allergies

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No known allergies

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Past Medical History

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Cardiomyopathy

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Heart failure

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Atrial fibrillation

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Chronic renal insufficiency [baseline SCr 1.8 mg/dL (159 μmol/L)]

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Social History

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Smokes ½ ppd of cigarettes

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Occasional alcohol use

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Home Medications

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Metoprolol tartrate 50 mg PO twice daily

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Ciclesonide nasal spray (50 mcg/spray) two sprays in each nostril daily

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Digoxin 250 mcg PO daily

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Enalapril 5 mg PO daily

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Potassium chloride 40 mEq (40 mmol) PO three times daily

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APAP 650 mg 1–2 tablets PO every 6 h as needed

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Spironolactone 25 mg PO daily

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Torsemide 100 mg PO daily

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Warfarin 5 mg PO daily

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Salt substitute with meals PRN

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Review of Systems

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Unattainable due to the patient's decreased mental status

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Physical Examination

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General
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Patient appears to be in moderate distress

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Vital Signs
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ED arrival: BP 68/36 mm Hg, P 34, RR 16, T 96.1°F (35.6°C)

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Weight: 229.9 lb (104.5 kg)

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Height: 74 in. (188 cm)

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Pain: Unknown because the patient does not respond appropriately to questions

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HEENT
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PERRLA, NG tube in place

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Neck
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Supple; (−) carotid bruits noted; (−) JVD

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Cardiac
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S1, S2; pulse irregularly irregular; no murmurs noted

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Respiratory
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Coarse ...

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