Question

10. A 71 year old male comes to his physicians office complaining of muscle weakness. The weakness began insidiously several weeks ago, and has now progressed to the point where he has difficulty with normal activities such as brushing his hair or sitting unsupported. Past medical history is significant for hyperlipidemia, chronic renal insufficiency, coronary artery disease, and coronary artery bypass and grafting. Current medications include atorvastatin, fosinopril, metoprolol, aspirin, and spironolactone. Physical examination reveals diminished deep tendon reflexes and decreased motor strength. Laboratory evaluation shows Na+ 143, K+ 7.4, Cl- 101, HCO3- 28, BUN 30, and creatinine 1.8. EKG is obtained on presentation and is seen here. What is the most appropriate initial step in the management of this patient?

A. Administer IV insulin and glucose
B. Administer po sodium polystyrene sulfate
C. Administer IV sodium bicarb
D. Administer IV calcium gluconate
E. Urgent hemodialysis

Answer 1

The most appropriate initial step in the management of the described patient, who has severe hyperkalemia, is urgent hemodialysis to quickly lower the dangerously high potassium level and avert cardiac complications.

Step-by-step explanation:

The patient in this scenario is presenting with muscle weakness and laboratory results indicating a high potassium level (hyperkalemia), specifically a K+ of 7.4. His symptoms and high potassium level pose an immediate threat to his cardiac function. In cases of severe hyperkalemia, the most appropriate initial step in the management of this patient would be urgent hemodialysis. This will rapidly lower the potassium level and prevent life-threatening cardiac arrhythmias. Other options such as administering IV insulin and glucose, sodium polystyrene sulfate, sodium bicarb, or calcium gluconate are adjunctive treatments that can be considered after initiating hemodialysis to further stabilize the patient.