Tuesday, September 20, 2005

On Call 3

A seventy year old man with advanced prostate cancer develops bilateral
ureteral obstruction and acute on chronic renal failure. His potassium
rises to 7.7 with peaked t waves. His medications include digoxin. The most
appropriate, safest initial therapy is

1. Hemodialysis
2. Percutaneous nephrostomy placement
3. Kayexalate
4. Intraveous glucose and regular insulin
5. Intravenous calcium gluconate

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1 comment:

Test said...

4. Intravenous glucose and regular insulin. #1, #2, and #3 cannot usually be performed soon enough and/or may not reduce the serum potassium quickly enough. #5 (calcium gluconate) is usually the initial therapy of choice, but intravenous calcium should be avoided or used cautiously when patients are on digoxin.