Case 030: Hyperkalemia

PATIENT PRESENTATION

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.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

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

FOLLOW-UP

How would you correct the hyponatremia?

Hint: See Electrolytes in PPP

CASE SUMMARY

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