Approach to hyperkalemia Quiz: Ace Your Exams

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A 65-year-old man presents to his primary care physician’s office to follow up on abnormal laboratory results. He previously had a potassium level of 5.6 mEq/L. His past medical history includes type 2 diabetes mellitus and stage 3 chronic kidney disease. The patient’s laboratory studies are listed below. Which of the following is the most likely cause of the previous hyperkalemia and the current laboratory results?  

 Laboratory study  Result 
 Potassium  5.7 mEq/L 
 Bicarbonate  22 mEq/L 
 Glucose  202 mg/dL 
 eGFR  35 mL/min/1.73m2 
 Creatine kinase  60 units/L 
 Aldosterone  8 ng/dL (supine) 
 Renin  0.1 ng/mL/hr (supine) 
 Serum osmolality  290 mOsm/kg H2O 

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