Correct!
5. All of the above
Each is a possible cause of hyperkalemia in this patient. She was begun on sodium polystyrene sulfonate (Kayexalate) orally and her potassium decreased to below 4. However, over several hours she developed a mental status change with decreasing responsiveness to questioning, increasing tachycardia, and finally oxygen desaturation with an increase in respiratory rate and labored breathing. A rapid response team was called and she was transferred to the ICU. She was intubated and placed on mechanical ventilation. She became hypotensive and her blood pressure was supported by norepinephrine infusion. A CT scan of the brain revealed no intracerebral hemorrhage or edema.
Initial electrolytes revealed an anion gap metabolic acidosis with a normal serum creatinine but a slightly elevated blood urea nitrogen. Her hemoglobin decreased from a baseline of 12.1 to 7.9 g/dL and her platelet count was decreased at 13,000 cells/mcL. There was no bloody discharge from her NG tube. Her serum lactate level was elevated at 6.3 mmol/L.
Which of the following need to be done next? (Click on the correct answer to move to the fourth of six pages)