ELECTROLYTE QUIZ

For each patient with hyperkalemia described below, select the best option (A-E) for treatment of their serum potassium.

A. Thiazide diuretic

B. Hydrocortisone

C. Insulin

D. Hemodialysis

E. Sodium polystyrene sulfonate

1. 43-year-old man with Type II diabetes mellitus, hypertension, congestive cardiac failure, nephrotic-range proteinuria, and a serum creatinine of 1.6 mg/dL. His serum potassium has been in the range of 5.6-5.9 mEq/L since starting captopril, despite adhering to a potassiumrestricted diet.

2. 88-year-old woman who had partial colectomy for perforated diverticular abscess and septicemia two days previously, and has been anuric since the operation. Her serum potassium is 6 mg/dL.

3. 18-year-old man with no prior medical history who presents with one week of polyuria and polydipsia.

Laboratory Studies

Serum sodium 132 mEq/L

Serum potassium 5.9 mEq/L

Serum chloride 91 mEq/L

Serum bicarbonate 16 mEq/L

Blood urea nitrogen 56 mg/dL

Serum creatinine 2.2 mg/dL

Serum glucose 330 mg/dL

4. 26-year-old woman with acquired immune deficiency syndrome, fatigue, weight loss, lowgrade fever, and orthostatic hypotension.

Serum cortisol level:

Baseline at 8 AM7 mcg/dL 

(nL 5-24 mcg/dL)

30 minutes after 250 10 mcg/dL mcg cosyntropin i.m.

60 minutes after 250.11 mcg/dL mcg cosyntropin i.m.