electrolyte imbalance

A 72-year-old woman is admitted to the hospital with increasing confusion and generalized weakness over the past week. Her medical history includes hypertension, for which she takes hydrochlorothiazide 25mg daily. On examination, she is lethargic and disoriented. Her blood pressure is 110/70 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Neurological examination reveals decreased reflexes. Initial laboratory investigations reveal the following: Sodium: 118 mmol/L Potassium: 3.8 mmol/L Chloride: 85 mmol/L Bicarbonate: 24 mmol/L Blood Urea Nitrogen (BUN): 25 mg/dL Creatinine: 1.1 mg/dL Glucose: 95 mg/dL Urine osmolality is 600 mOsm/kg. Serum osmolality is 250 mOsm/kg. Which of the following is the most appropriate initial management strategy?

A 72-year-old man with a history of hypertension, type 2 diabetes, and chronic kidney disease (CKD) presents to his general practitioner for a routine check-up. His current medications include metformin, insulin glargine, amlodipine, and aspirin. His blood pressure today is 150/90 mmHg. Laboratory results show a serum creatinine of 2.5 mg/dL (baseline 2.0 mg/dL), potassium of 5.4 mEq/L, and a urine albumin-to-creatinine ratio (ACR) of 350 mg/g. The GP decides to add an ACE inhibitor to his medication regimen to help manage his blood pressure and proteinuria. One week later, the patient returns complaining of fatigue and muscle weakness. Repeat laboratory testing reveals a serum creatinine of 3.1 mg/dL and a potassium of 6.2 mEq/L. Which of the following is the most appropriate next step in managing this patient?

A 72-year-old man with a history of chronic kidney disease stage 4, hypertension, and type 2 diabetes presents to the emergency department with confusion and lethargy. His family reports that he has been increasingly drowsy over the past two days. On examination, he is disoriented to time and place, with a blood pressure of 150/90 mmHg, heart rate of 88 bpm, respiratory rate of 20 breaths per minute, and temperature of 36.5°C. Laboratory tests reveal: sodium 130 mmol/L, potassium 5.8 mmol/L, bicarbonate 18 mmol/L, urea 25 mmol/L, creatinine 450 µmol/L, and glucose 8 mmol/L. An ECG shows peaked T waves. What is the most appropriate immediate management step?

A 3-week-old male presents with non-bilious projectile vomiting after each feed. He is otherwise well-appearing. An abdominal X-ray is unremarkable. An upper GI contrast study is performed, and relevant images are shown. What is the MOST likely acid-base disturbance in this patient?

A 68-year-old woman with a history of hypertension and heart failure is being treated with an ACE inhibitor. Her recent blood tests show a potassium level of 5.8 mmol/L. Which of the following is the most appropriate initial step in managing her hyperkalemia?

A 3-week-old male infant is brought to the emergency department by his parents due to persistent, non-bilious vomiting after each feeding for the past week. The vomiting has become increasingly forceful. The infant appears mildly dehydrated, and his weight has remained stable since birth. On examination, an olive-shaped mass is palpated in the epigastric region when the infant is not actively vomiting. An upper GI series is performed, and the image is shown. What is the most appropriate next step in the management of this patient?

A 5-week-old male presents with projectile vomiting. Ultrasound (shown). What electrolyte abnormality is MOST likely?

A 68-year-old woman with a history of hypertension and heart failure is admitted to the hospital with increasing shortness of breath and peripheral edema. She is currently taking furosemide 40mg daily. Her blood tests reveal the following: Na+ 130 mmol/L (135-145 mmol/L), K+ 3.1 mmol/L (3.5-5.0 mmol/L), Cl- 95 mmol/L (98-107 mmol/L), HCO3- 32 mmol/L (22-29 mmol/L). What is the most appropriate initial management?

A 68-year-old woman is admitted to the hospital with confusion and muscle weakness. Her medications include hydrochlorothiazide for hypertension. Initial laboratory results show: Sodium 120 mmol/L (Normal: 135-145 mmol/L), Potassium 3.8 mmol/L (Normal: 3.5-5.0 mmol/L), Chloride 90 mmol/L (Normal: 95-105 mmol/L). What is the most likely cause of her hyponatremia?

A 68-year-old woman with a history of heart failure presents to the emergency department with increasing shortness of breath and lower extremity edema. She has been taking furosemide 40mg daily for the past year. Her blood pressure is 110/70 mmHg, heart rate is 90 bpm, and respiratory rate is 24 breaths/min. An ECG shows flattened T waves and prominent U waves. Which of the following is the most likely electrolyte abnormality contributing to her presentation?

A 72-year-old man with a history of hypertension, type 2 diabetes, and chronic kidney disease (CKD) presents to his general practitioner for a routine check-up. His current medications include metformin, insulin, amlodipine, and aspirin. His blood pressure today is 150/90 mmHg. Laboratory results show a serum creatinine of 2.5 mg/dL (221 micromol/L) and a potassium level of 5.4 mEq/L. The GP decides to add an ACE inhibitor to his treatment regimen to help manage his blood pressure and provide renal protection. One week later, the patient returns complaining of fatigue and muscle weakness. Repeat laboratory tests reveal a serum creatinine of 3.1 mg/dL (274 micromol/L) and a potassium level of 6.2 mEq/L. Which of the following is the most appropriate next step in managing this patient?

A 4-week-old male presents with non-bilious emesis. An upper GI series is performed (image shown). What acid-base abnormality is MOST likely?

A 70-year-old man with a history of hypertension and type 2 diabetes mellitus is being treated with an ACE inhibitor. His medications include metformin, gliclazide and perindopril. He presents to the emergency department complaining of lightheadedness and dizziness, particularly when standing up. His blood pressure is 90/60 mmHg, and his heart rate is 70 bpm. His electrolytes show a potassium level of 6.2 mmol/L. Which of the following is the most likely cause of his hyperkalemia?

A 3-week-old male presents with projectile vomiting. Upper GI series (image shown). What electrolyte abnormality is MOST likely?

A 62-year-old woman presents to the emergency department with confusion and lethargy. Her family reports she has been increasingly forgetful over the past week and has had a decreased appetite. She has a history of type 2 diabetes mellitus and hypertension, for which she takes metformin and lisinopril. On examination, she is disoriented to time and place, with dry mucous membranes and decreased skin turgor. Her blood pressure is 100/60 mmHg, heart rate is 110 bpm, and temperature is 37.2°C. Laboratory tests reveal a serum sodium level of 118 mmol/L, serum osmolality of 260 mOsm/kg, and urine osmolality of 500 mOsm/kg. Which of the following is the most appropriate initial management for this patient?

A 4-week-old male presents with persistent non-bilious vomiting after feeding. He is mildly dehydrated, but otherwise active. An ultrasound is performed, as shown. What is the MOST likely acid-base disturbance?

A 6-week-old male presents with persistent non-bilious vomiting after feeding. He appears hungry and has lost weight since birth. Examination reveals visible peristaltic waves across the abdomen. An abdominal ultrasound is performed, as shown. What is the most likely acid-base disturbance seen in this patient?

A 4-week-old male presents with projectile vomiting after feeding. He is irritable and appears mildly dehydrated. An abdominal exam reveals a palpable, olive-shaped mass in the epigastrium. An upper GI contrast study is performed, and relevant images are shown. What is the MOST appropriate initial step in managing this patient's electrolyte imbalance?

A 3-week-old male infant presents with persistent, non-bilious projectile vomiting after each feed. He appears hungry and eagerly accepts the bottle, but vomits shortly after. On examination, mild dehydration is noted. An abdominal X-ray is ordered, the relevant image is attached. What is the MOST appropriate next step in management?

A 6-week-old male infant presents with a 2-week history of progressively worsening projectile non-bilious vomiting after feeds. He has lost weight and appears lethargic. Initial bloods show a hypochloremic, hypokalaemic metabolic alkalosis. After fluid resuscitation, the image is obtained. What is the most appropriate definitive management for this patient?

A 6-week-old male infant presents to the emergency department with a 2-week history of progressively worsening non-bilious vomiting, which has become projectile over the past few days. His parents report he is feeding eagerly but vomits most feeds shortly after completion. He has had fewer wet nappies than usual and appears more lethargic. On examination, he is irritable but consolable. His weight is below the 3rd percentile, having dropped from the 10th percentile at birth. Vital signs are: Temperature 36.8°C, Heart Rate 155 bpm, Respiratory Rate 40 bpm, Blood Pressure 85/50 mmHg, Oxygen Saturation 98% on room air. Capillary refill time is 3 seconds. Abdominal examination reveals a soft, non-distended abdomen with active bowel sounds; no palpable masses are appreciated. Initial blood gas shows pH 7.52, pCO2 40 mmHg, Bicarbonate 32 mmol/L, Na+ 132 mmol/L, K+ 3.0 mmol/L, Cl- 88 mmol/L. A point-of-care ultrasound was performed, and the image provided was obtained. Considering the clinical presentation and the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this infant?

A 6-week-old male infant presents to the emergency department with a 5-day history of progressively worsening non-bilious vomiting, which has become projectile over the past 48 hours. He is exclusively formula-fed and his parents report decreased wet nappies and increased irritability. On examination, he is alert but appears slightly lethargic. His weight is below his birth weight. Capillary refill time is 3 seconds. Vitals are: HR 150 bpm, RR 40 bpm, T 37.2°C, BP 85/50 mmHg. Abdominal examination is soft, non-distended, and no masses are definitely palpable. Initial blood gas shows pH 7.52, pCO2 40 mmHg, HCO3 32 mmol/L, Na+ 130 mmol/L, K+ 3.0 mmol/L, Cl- 85 mmol/L. Urea and creatinine are mildly elevated. An imaging study was performed, shown above. Considering the clinical presentation and the findings on the imaging study, which of the following is the most critical immediate management step?

A 5-week-old male presents with non-bilious projectile vomiting after each feed for the past week. He is alert but appears dehydrated. An ultrasound is performed, as shown. What electrolyte abnormality is MOST likely present?

A 5-week-old male presents with non-bilious projectile vomiting. An ultrasound is performed (shown). What acid-base disturbance is MOST likely?

A 6-week-old infant presents with a 1-week history of increasing frequency of non-bilious, projectile vomiting occurring shortly after feeds. He has lost some weight since his last check-up. Examination is otherwise unremarkable. An ultrasound is performed, shown in the image. Based on the clinical presentation and the provided image, which of the following electrolyte abnormalities is the most likely consequence if this condition remains untreated?

A 72-year-old woman is admitted to the hospital with increasing confusion and generalized weakness over the past week. Her medical history includes hypertension, for which she takes hydrochlorothiazide 25mg daily. On examination, she is lethargic but arousable. Her blood pressure is 110/70 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Neurological examination reveals decreased reflexes. Initial laboratory investigations reveal the following: Sodium 118 mmol/L, Potassium 3.8 mmol/L, Chloride 85 mmol/L, Bicarbonate 24 mmol/L, BUN 15 mg/dL, Creatinine 0.8 mg/dL, Glucose 90 mg/dL. Urine osmolality is 600 mOsm/kg. Serum osmolality is 250 mOsm/kg. Which of the following is the most appropriate initial management strategy?

A 5-week-old male infant presents with a 10-day history of non-bilious, forceful vomiting after every feed. His parents report decreased wet nappies and lethargy. On examination, he is pale, weighs 3.2 kg (birth weight 3.5 kg), has sunken eyes, and poor skin turgor. Vital signs: HR 170, RR 45, Temp 37.0, BP 80/50. Initial bloods show Na 132, K 3.1, Cl 88, HCO3 30. An imaging study is performed, shown in the image. Considering the clinical presentation and the findings demonstrated in the imaging study, what is the most appropriate immediate management priority for this infant?

A 78-year-old woman with a history of heart failure (reduced ejection fraction), type 2 diabetes, and recent hospitalisation for pneumonia presents to her GP with increasing fatigue and a single episode of dizziness leading to a fall without loss of consciousness. Her current medications are Digoxin 125 mcg daily, Furosemide 40 mg daily, Ramipril 5 mg daily, Metformin 500 mg BD, and Amoxicillin 500 mg TDS (started 5 days ago for pneumonia). An ECG in clinic shows sinus rhythm, rate 70 bpm, and a QTc of 530 ms. An ECG from 6 months prior had a QTc of 440 ms. Recent laboratory tests show Na 138 mmol/L, K 4.2 mmol/L, Mg 0.9 mmol/L, Ca 2.3 mmol/L, Creatinine 90 µmol/L, and Digoxin level 1.1 ng/mL. Considering the clinical context and investigations, which of the following is the most likely significant contributor to the observed QTc prolongation?

A 4-week-old male presents with persistent projectile vomiting after feeding. He is otherwise well-appearing. An upper GI series is performed, with relevant images attached. What acid-base disturbance is MOST likely present?

A 3-week-old male infant is brought to the emergency department by his parents. They report that he has been experiencing projectile vomiting after every feed for the past week. The vomiting is non-bilious. He appears dehydrated, with sunken fontanelles and decreased skin turgor. His weight has decreased since his last check-up. An abdominal X-ray is ordered, the results of which are shown. What is the most appropriate next step in the management of this patient?

A 62-year-old woman with a 15-year history of type 2 diabetes mellitus presents to the emergency department with confusion, polyuria, and polydipsia over the past three days. She has been non-compliant with her medications and diet. On examination, she is lethargic and dehydrated, with a blood pressure of 100/60 mmHg, heart rate of 110 bpm, and respiratory rate of 20 breaths per minute. Laboratory tests reveal a blood glucose level of 38 mmol/L, serum sodium of 150 mmol/L, serum potassium of 4.0 mmol/L, serum bicarbonate of 22 mmol/L, and a serum osmolality of 340 mOsm/kg. Urinalysis shows no ketones. Which of the following is the most appropriate initial management step?

A 6-week-old male infant presents with a 1-week history of progressively worsening non-bilious vomiting, often projectile, occurring shortly after feeds. His parents report he is constantly hungry and irritable but has had poor weight gain. On examination, he is alert but appears thin. Vital signs are stable. Abdominal examination is soft, non-tender, with no palpable mass. An abdominal ultrasound is performed, the image of which is shown. Considering the clinical presentation and the findings depicted, what is the most appropriate definitive management strategy after initial fluid and electrolyte correction?