Electrolyte Games for Rainy Afternoons

Abstract

Correlate the clinical histories with the electrolytes presented. Answers are below.A. Serum calcium 4.8 mg/dL B. Urinary electrolytes: sodium 110 mEq/L; potassium 46 mEq/L; chloride 90 mEq/L C. Serum potassium 6.7 mEq/L D. Serum sodium 125 mEq/L E. Serum calcium 5.8 mEq/L 1. A 39-year-old man with recently diagnosed nephrotic syndrome secondary to steroid-resistant focal segmental glomerular sclerosis (FSGS) was admitted to the hospital 4 weeks after cyclosporine A was added to therapy, which had caused him to become encephalopathic. His blood sugar on admission was 900 mg/dL. 2.A 65-year-old woman with a documented diagnosis of myelofibrosis was admitted to the hospital because of increasing weakness. On admission, hemoglobin was 6.9 g/dL and platelet count was 1 million.3. A 55-year-old woman with carcinoma of the breast underwent magnetic resonance imaging of the chest with intravenous gadolinium for evaluation of suspected metastatic disease. 4.A 24-year-old woman came to the hospital because of profound weakness. Serum electrolytes upon admission showed a potassium level of 2.8 mEq/L, chloride of 88 mEq/L, bicarbonate of 35 mEq/L, and sodium of 140 mEq/L. She denied vomiting or diuretic use. 5.A 60-year-old man with end-stage renal failure for the last 15 years had severe secondary hyperparathyroidism (PTH levels > 1500) despite attempting to suppress parathyroid hormone production with nearly maximal doses of vitamin D (Hectorol 10 MIC IV after each dialysis) and calcimimetics (Sensipar 90 mg/day). The beneficial effects of both drugs were limited by evolving hypercalcemia (vitamin D analogue) and gastrointestinal symptoms (Sensipar). In view of erythropoietin resistance (early myelosclerosis due to PTH excess) and risk of calcific arteriopathy, the patient underwent total parathyroidectomy and parathyroid tissue implant in the forearm.