What investigation should be performed next?
Answer: Serum potassium
Tall tented T-waves is an ECG feature of hyperkalaemia. In this case, the cause of hyperkalaemia is a combination of potassium-sparing drugs and obstructive uropathy.
Case Discussion:
Hyperkalemia:
Hyperkalemia is a medical term that describes a condition in which the blood levels of potassium becomes higher than normal ( > 5.5 mEq/l)
High potassium levels in blood can be very dangerous and needs immediate treatment.
Clinical Features: Many patients with hyperkalemia may be asymmtomatic , while some may present with:
- Malaise
- Palpitations
- Muscle weakness
- Mild hyperventialtion
- Chest pain
- Nausea or vomiting.
The presence of a risk factor and clinical history of other underlying medical disorders or drug intake is important clue for diagnosis.
Causes: Include:
- Acute renal failure
- Chronic kidney disease
- Medications like ACE inhibitors, potassium sparing diuretics (spironolactone), NSAIDs, Trimethoprim, ciclosporin
- Addisons disease
- Aldosterone deficiency
- Excess use of potassium supplements
- Destruction of red blood cells secondary to severe burns or injury.
- Pseudohyperkalemia (excessive leakage of potassium from cells during or after blood withdrawal )
Management:
1. When potassium levels exceed 6.6 mmol/l emergency treatment is needed to prevent cardiac arrhythmia and sudden death.
2. When there are no ECG abnormalities and when there is only moderate elevation in potassium levels , exertion can be facilitated by cation exchange resin or diuretics, and the source of excess potassium buildup should be controlled (e.g stop the causative drug)
3. Severe cases and patients with renal failure are treated with hemodialysis.
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