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QJM Advance Access published online on March 10, 2005
QJM, doi:10.1093/qjmed/hci046
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Masterclasses in medicine

An approach to the patient with severe hypokalaemia: the potassium quiz

J.H.M. Groeneveld 1, Y.W.J. Sijpkens 1, S.-H. Lin 2, M.R. Davids 3, and M.L. Halperin 4*

1 Department of Nephrology, Leiden University Medical Center, The Netherlands
2 Renal division, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (ROC)
3 Nephrology Unit and Department of Internal Medicine, Stellenbosch University, Cape Town, South Africa
4 Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Canada

* To whom correspondence should be addressed.
M.L. Halperin, E-mail: mitchell.halperin{at}utoronto.ca


  Abstract

The objective of this teaching session with Professor McCance is to develop an approach to the management of patients with a very low plasma potassium (K+) concentration (PK). The session begins with a quiz based on six recent medical consultations for a PK < 2 mmol/l. Professor McCance outlined how he would proceed with his diagnosis and therapy, using the synopsis that described each patient. This approach was then applied to a new patient, a 69-year-old woman who had a large volume of dependant oedema and developed a severe degree of weakness and hypokalaemia during more aggressive diuretic therapy that included a K+-sparing diuretic. The initial challenge for Professor McCance was to deduce why the K+-sparing diuretic was not effective in this patient. He also needed to explain why the PK was so low on admission.


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