Therapeutically:

EKG did not show any evidence of hyperkalemia – specifically no PT waves, no widened QRS and no sinusoidal wave.

Given hyperkalemia and hypocalcemia, patient was empirically treated with calcium gluconate 2 g. However given unknown baseline and risk for deterioration into potential fatal arrhythmia, patient was additionally given insulin 5 units IV (additional insulin bodes high outweighing risk for hypoglycemia given elevated Cr and decreased clearance of insulin) with an amp of D50 with request for every 30 minutes point-of-care glucose checks, albuterol 5 mg, bicarbonate 1 amp, Lasix 40 mg IV and Kayexalate. Aggressive intravenous fluids are contraindicated given that patient is at risk for volume overload, pulmonary edema.

Etiology: Hyper-kalemia likely secondary to end-stage renal disease requiring dialysis and missed dialysis for 2 weeks.

Repeat BMP ordered.

Arranging for dialysis. 

See BIG K Drop