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Chief Complaint

Chest Pain

History of Present Illness

Tim Tower is a 46-year-old male presented to the emergency department with chest pain that started this morning. Pain is described as a moderately severe, dull, constant ache, associated with diaphoresis, orthopnea, nausea, vomiting, and fatigue. Denies upper respiratory symptoms. Known systolic heart failure, EF (15-20%) secondary to Duchenne Muscular Dystrophy gene mutation. Cardiology heart failure clinic records indicate multiple drug doses of furosemide, potassium chloride, and sacubitril/valsartan were changed over the last three days.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  1. What are the signs and symptoms of hyperkalemia in this patient?

    Hint: See Electrolytes in PPP

  2. What are the most likely causes of this patient’s hyperkalemia?

    Hint: See Electrolytes in PPP

  3. Did this patient present with an acid base disorder?

    Hint: See Etiology and Treatment in PPP

  4. What medications could have contributed to the hyperkalemia and acute kidney injury in this patient?

    Hint: See Electrolytes in PPP

  5. What are the treatment options for hyperkalemia?

    Hint: See Electrolytes in PPP


How would you correct the hyponatremia?

Hint: See Electrolytes in PPP


Global Perspective

Hyperkalemia is a common electrolyte disorder with potential life-threatening consequences. It is associated with various medications (inhibitors of the renin-angiotensin-aldosterone system, potassium-sparing diuretics, non-steroidal anti-inflammatory agents, and sulfamethoxazole-trimethoprim) and comorbid illnesses (kidney disease, heart failure, diabetes, and acidosis). Treatment involves three sequential steps: (1) Cardiac membrane stabilization with calcium salts; (2) shifting potassium intracellularly with insulin, albuterol and/or bicarbonate; and (3) definitive removal of potassium from the body with diuretics, potassium binding agents, and/or hemodialysis.

Key References

1. +
Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving global outcomes conference. Linder  G, Burdman  EA, Clase  CM  et al. European Journal of Emergency Medicine 2020; 27:329–337.  [PubMed: 32852924]

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