![]() ![]() Pseudohyperkalemia due to hemolysis of blood sample is the most common cause of hyperkalemia, and therefore redrawing a new blood sample is important. She was admitted to the intensive care unit for close monitoring of her rhythm and neurologic status. ECG showed sinus arrest with ectopic atrial rhythm and intermittent junctional escape beats (Figure (Figure1). Calcium level was normal, and blood gas results were as follows: pH of 7.28, pCO 2 of 32 mm Hg, pO 2 of 99 mmHg, and HCO 3 of 12.8 mmol/L. Laboratory work-up was significant for a potassium level of 8.6 mEq/L and creatinine of 12.2 mg/dL. Physical examination demonstrated lethargy, confusion, and volume overload. Her blood pressure was 131/58 mmHg with an irregularly irregular heart rate of 87 beats per minute. Her home medicines included aspirin, atorvastatin, amlodipine, carvedilol, hydralazine, and ergocalciferol. She had missed her last hemodialysis session and denied any chest pain. She presented to the emergency department accompanied by her son due to generalized weakness, dyspnea on exertion, and mild confusion for the past three days. She had been anuric and on hemodialysis for four years. An 80-year-old female presented with a past medical history of hypertension, type II diabetes mellitus, transient ischemic attack, and end-stage renal disease due to diabetic nephropathy.
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