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 |
| 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:
|
| Approved | Approved::No |
| Keyword | WBRKeyword::hyperkalemia, WBRKeyword::pseudohypokalemia |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
