QuestionSBA
QuestionChoice
This may be required in advanced refractory cases but is not immediately indicated at present. Indications for acute dialysis include refractory hyperkalaemia, fluid overload, toxin ingestion, and uraemia.
10035613
b
Arrange urgent haemodialysis
QuestionChoice
This is likely to form part of the initial management of his hyperkalaemia but the priority is protecting the heart and administering plenty of fluids to improve the AKI and rhabdomyolysis.
10035616
e
Administer insulin dextrose
QuestionChoice
This is correct. The patient is presenting with signs and symptoms of rhabdomyolysis as suggested by a long lie, hypocalcaemia and severe stage 3 acute kidney injury due to the release of myoglobin from dying muscle cells. Calcium gluconate protects the heart and stabilises the myocardium given the hyperkalaemia.
10035612
a
Aggressive fluid resuscitation and calcium gluconate
QuestionChoice
This may play a part later on in optimising AEDs to reduce the frequency of seizures (and possible subsequent long lies).
10035614
c
Arrange urgent nephrology review
QuestionChoice
This is not appropriate as this patient is very unwell with a stage 3 AKI and severe hyperkalaemia and he could go into cardiac arrest without appropriate treatment.
10035615
d
Discharge with outpatient nephrology review
Concept
Chapter
2693
4410
Rhabdomyolysis
Topic
142
Nephrology
19526
In rhabdomyolysis, aggressive fluid resuscitation and calcium gluconate are crucial to manage hyperkalaemia and protect cardiac function.
A 28-year-old gentleman with poorly controlled epilepsy is brought into hospital by his family following a collapse at home. He was previously last seen by his neighbour a day ago.

Bloods demonstrate a Sodium of 134mmol (135-145), K 6.9mmol (3.5-5.2), Urea 19mmol (1.8-7), Creatinine 630μmol (59 - 104) and an adjusted calcium of 1.84mmol (2.2-2.6).

What is the most appropriate initial course of action?
a