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Case 1.3

Educational resources for renal medicine

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Case 1.3

You administer 500mls of normal saline.  

  • His blood pressure rises to 125/80 (previously 100/60)
  • And his urine output improves:  2100 - 8ml; 2200 - 45ml

You also perform some blood tests (normal range in brackets)

 Sodium  131mmol/l (135-145)
 Potassium  7.1mmol/l (3.6-5.0)
 Total CO2  17mmol/l (22-30)
 Urea 19.1mmol/l (2.5-6.6)
 Creatinine  211umol/l (60-120)
 eGFR  28mls/min  



Question 4

What do you do in the first instance?

(a)  Continue giving fluids. His renal function will improve with time and he will excrete potassium in his select urine.

(b)  Give insulin and dextrose to allow him to move potassium into his cells. This will lower his potassium. As his total CO2 is low some bicarbonate might be useful in moving potassium into cells.

(c)  Check an ECG and give him IV calcium to stabilise his cardiac membrane.

(d)  Stop his ACE inhibitor (lisinopril), spironolactone and non-steroidal (diclofenac acid) as all of these will lead to potassium retention and/or reduced GFR.

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Page last modified 30.11.2016, 10:06 by Emma Farrell. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.