Background:   Hyperkalemia (HK; serum K+ ≥5.0mEq/L) is a common electrolyte imbalance, associated with an increase in all-cause mortality and hospitalization.  Moderate to severe HK (K + levels ≥5.5mEq/L) is often managed in the emergency department or hospital, where available treatment options include methods to temporarily lower K+ (e.g., insulin-glucose and beta 2 agonists), use [...]

Background: Hyperkalemia occurs frequently in diabetes. Sodium zirconium cyclosilicate (SZC), an oral, selective potassium (K) binder, rapidly reduces K in patients (pts) with hyperkalemia and has been shown to maintain normokalemia for up to 1 y. We compared the response to SZC in adults with and without diabetes mellitus (DM, type 1/2) in a 12 [...]

Background: The use of IV insulin is one of the primary therapeutic options for the treatment of hyperkalemia. Unfortunately the available literature reports that hypoglycemia is a common occurrence as a result of the treatment of hyperkalemia. During our safety event review process, we identified the same issue within our own institution. Due to reports [...]

Case Presentation: A 73 year-old female with a history of recurrent DVT’s on Warfarin, microscopic polyangiitis and ulcerative colitis status post total colectomy initially presented with altered mental status. Lab workup revealed acute renal failure for which she underwent intermittent hemodialysis. Due to a suspicion for microscopic polyangiitis relapse, the patient was started on steroids. [...]

Case Presentation: A man in his 70s with a history of hypertension, CAD, and diabetes presented to the ED with severe bradycardia, nausea, vomiting, and weakness. EMS had administered atropine en route to the ED. His EKGs in the ED showed a junctional rhythm with obliterated p waves and ventricular escape complexes, and labs showed [...]

Case Presentation: A 57-year-old male with previous hemorrhagic stroke complicated by residual left sided deficits with vascular dementia, primary hypertension on a regimen of carvedilol 25mg twice daily, and recurrent urinary tract infections due to obstructive calculi presented with acute-onset lethargy and encephalopathy. Presenting vitals were notable for hypotension (64/53), bradycardia (43 beats per minute), [...]

Case Presentation: A 60-year-old male with chronic kidney disease 3a, hypertension (HTN) and type 2 diabetes was found unresponsive at work. The patient’s home medications were carvedilol, nifedipine, spironolactone and valsartan for his resistant HTN. Initial evaluation revealed undifferentiated shock with an inappropriately low heart rate of 40 beats per minute. Labs showed potassium of [...]

Case Presentation: A 46-year-old male with a history of HFpEF on Entresto presented for fatigue, lymphadenopathy, and severe back pain. He was diagnosed with Renal Cell Carcinoma (RCC) and was pending oncologic evaluation. On admission, his potassium and platelet levels were within normal limits. However, within the next two weeks, those levels would rise. Potassium [...]

Case Presentation: A 78-year-old man with atrial fibrillation on amiodarone and rivaroxaban, heart failure with reduced ejection fraction (HFrEF) on metoprolol and furosemide, hypertension on amlodipine and lisinopril, type 2 diabetes on metformin, and chronic kidney disease, presented with several weeks of progressive lethargy and confusion in the setting of chronic functional and cognitive decline.He [...]

Case Presentation: A 56-year-old man with history of hypertension on amlodipine, hydralazine, losartan, spironolactone, and torsemide, uncontrolled insulin dependent type 2 diabetes mellitus, chronic kidney disease (CKD) stage IIIb, and chronic lymphocytic leukemia (CLL) with extreme leukocytosis of 268,600/uL on admission presented to the hospital for progressive shortness of breath and was found to be [...]