Take a look at some initial diagnostic testing below!
Basic labs
The ED tells you that they have already given the patient 10 units of regular insulin, 1 g of intravenous calcium gluconate, and 30 g of kayexalate.
Which of the following at the next best steps (more than one may be correct!)
Urgently place temporary dialysis catheter and arrange for hemodialysis against a potassium-free dialysate.
Not so fast! There are a few more appropriate options here.
Draw another sample to check a plasma potassium and walk it to the lab.
Nailed it! This value is 4.2 meq/L.
Repeat the plasma potassium and try to draw the sample without a tourniquet.
The labs calls you urgently to tell you that the potassium is still very high.
Check a serum potassium level in a tube with sodium citrate and EDTA (ethylenediaminetetraacetic acid)
Not quite…try again!
Check a 12-lead electrocardiogram (ECG)
Great! A serum potassium of 7.5 meq/L should prompt an ECG in any patient. Here is the patient’s ECG:
Perform a kidney biopsy.
Ouch! This patient’s creatinine is within the normal range. We don’t have any other data suggesting that a kidney biopsy may be helpful here. Try again!
So what happened here? Click here to wrap up this case!
Case 27 Index
Case 27 Introduction
Case 27 Physical Exam