Chronic kidney disease Quiz: Ace Your Exams

A 62-year-old man was sent to the emergency department due to abnormal labs that his primary care PA had drawn yesterday. The patient has had viral gastroenteritis with several episodes of vomiting and diarrhea over the past few days, his symptoms are now resolved. He has a past medical history of hypertension and chronic kidney disease. Temperature is 37.0 ºC (98.6 ºF), pulse is 90/min, blood pressure is 98/56 mmHg, and SpO2 is 100% on room air. On physical examination, the patient has dry mucous membranes. There is no abdominal tenderness to palpation. Mild pitting edema is present in both lower extremities up to the mid-tibia. Electrocardiogram is performed and shows normal sinus rhythm with no abnormalities. Bloodwork is drawn and results are shown below. The patient is given nebulized albuterol as well as IV calcium gluconate, insulin, and 50% dextrose solution. Which of the following is the next best step in management?

Serum Test	Lab Value	Reference Range
Sodium	131 mEq/L	136-146 mEq/L
Potassium	6.6 mEq/L	3.5-5 mEq/L
Chloride	90 mEq/L	95-105 mEq/L
Bicarbonate	18 mEq/L	22-28 mEq/L
BUN	60 mg/dL	7-18 mg/dL
Creatinine	2.2 mg/dL (Patient’s baseline: 1.8 mg/dL)	0.6-1.2 mg/dL
eGFR	33 mL/min/1.73 m²	≥ 90 mL/min/1.73 m²
Calcium	7.8 mg/dL	8.4-10.2 mg/dL