Saturday, September 10, 2005

On Call

A 65 year old man with diabetes presents with vomiting and weakness. His
baseline creatinine is 2.

He appears dry. His labs reveal potassium 5, bicarb 9, anion gap 24, BUN
115, creatinine 5. The calcium is 4.8 with an albumin of 4. The ECG shows a
prolonged QTc. His phosphorous is 12. An ABG shows a pH of 7.13 with
adequate respiratory compensation.

Your treatments may include one or more of the following: IV fluids,
bicarb, calcium, and dialysis.

Which should you not do first?

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1 comment:

Test said...

Bicarbonate should not be given first. Aggressive correction of acidosis may lower ionized calcium further.