WBR0904

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Electrolytes
Prompt	[[Prompt::A 70 year old male patient is hospitalized for pneumonia requiring an IV course of antibiotics. On the third day of hospitalization, the patient reports less dyspnea and shows overall clinical improvement. His vital signs are: temperature of 37.2 degrees celsius, blood pressure of 120/68 mmHg and heart rate of 70 bpm. The patient has a previous history of myocardial infarction and hypertension. His medications include aspirin, statin and ACE inhibitors. His electrolytes ordered in the morning show the following results: Sodium: 139 mEq/L Potassium: 5.5 mEq/L Calcium: 10 mg/dl Phosphorus: 3.9 mg/dl Magnesium: 1.68 mg/dl Which of the following is a first step in the management of the patient?]]
Answer A	AnswerA::Repeat blood test
Answer A Explanation	AnswerAExp::
Answer B	AnswerB::Administer IV saline
Answer B Explanation	AnswerBExp::
Answer C	AnswerC::Order an EKG
Answer C Explanation	AnswerCExp::
Answer D	AnswerD::Administer calcium gluconate
Answer D Explanation	AnswerDExp::
Answer E	AnswerE::Discontinue his hypertension medication
Answer E Explanation	AnswerEExp::
Right Answer	RightAnswer::A
Explanation	[[Explanation::The patient has a potassium level >5.5 mEq/L consistent with hyperkalemia. Hyperkalemia often has no symptoms. Occasionally, people may experience irregular heartbeat, nausea, slow, weak, or absent pulse. Extreme degrees of hyperkalemia are considered a medical emergency due to the risk of potentially fatal arrhythmias. A detailed history taking is very helpful in diagnosing the cause of hyperkalemia. The first step in the management of hyperkalemia is to rule out pseudohyperkalemia. Shown below is an algorithm summarizing the first steps in the management of hyperkalemia: Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::hyperkalemia, WBRKeyword::pseudohypokalemia
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::