A 78-year-old man known to have type 2 diabetes mellitus, hypertension, and chronic kidney disease is complaining of fatigue and nausea. He denies any change in consciousness, seiz... A 78-year-old man known to have type 2 diabetes mellitus, hypertension, and chronic kidney disease is complaining of fatigue and nausea. He denies any change in consciousness, seizures, abdominal pain, vomiting, chest pain, or shortness of breath. He is on insulin, lisinopril, amlodipine, erythropoietin, and vitamin D. Examination reveals that he is drowsy but not in distress (see lab results). Which of the following is the most appropriate next step in management? A. NaHCO3 B. D5 water C. Diuretics D. Calcium gluconate
Understand the Problem
The question is asking which management step is most appropriate for a 78-year-old man with type 2 diabetes, hypertension, and chronic kidney disease who is presenting with fatigue and nausea, while denying other significant symptoms. This will involve evaluating the clinical scenario and the provided options to determine the most suitable intervention.
Answer
Calcium gluconate
Administer Calcium gluconate.
Answer for screen readers
Administer Calcium gluconate.
More Information
Given the patient's symptoms and the medications he is currently on, he is likely experiencing hyperkalemia due to chronic kidney disease and the use of ACE inhibitors like lisinopril. Administering calcium gluconate helps stabilize the heart muscle membranes, which can be affected by elevated potassium levels.
Tips
A common mistake is to not consider drug interactions and their long-term effects, particularly with chronic conditions like kidney disease.
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