Metabolic and Electrolyte Emergencies Case #2
“A 44 year old male presents to the Emergency Department feeling generally unwell and lethargic. He has felt this way for the last 2 months and has been sleeping longer during the day.”
He denies any pain but has mild abdominal discomfort. He denies any other symptoms. He was sent in after seeing his GP who performed a blood test. He is hypertensive and takes Ramipril once daily. He has no significant family or social history.
On Examination
Obs: HR 92, RR 16, BP 134/76, Temp 36.8, SpO2 99%
CVS: Unremarkable
Respiratory: Unremarkable
Abdominal: Mild discomfort in flanks and umbilical region but no guarding or tenderness
Neurological: Unremarkable
His GP has written a note to come with the patient saying: "Dear Dr. Please review this gentleman whose latest potassium on blood testing was 7.1mmol/L."
Questions
Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:
What are the most common causes of hyperkalaemia?
How would you initially assess this man, and what specific steps would you undertake?
What further investigations would you like to undertake and why?
What specific ECG changes may you see with hyperkalaemia?
What specific ECG changes may you see with hypokalaemia?
How would you manage this patient in the Emergency Department?
What are the causes of spurious hyperkalaemia?
