Persistent Severe Hyperkalemia in a Patient with Normal Renal Function

Case Report A 75-year-old female with a past medical history significant for hypertension, hyperlipidemia, and colon cancer, status post colectomy with ileostomy, presented to the Methodist Hospital emergency room with muscular low back pain, which began a few hours prior, after abruptly bending over. Upon arrival to the hospital, she had no other complaints and noted that the back pain was starting to resolve without intervention. In triage, her heart rate was measured at 38 beats per minute (BPM) with her other vital signs within normal limits. Her electrocardiogram (EKG) was read as a junctional rhythm with a rate of about 40 BPM, and a wide-complex QRS with what appeared to be a new Right Bundle Branch Block morphology. Previous EKGs, including one from less than a year earlier, were unremarkable. Basic laboratory studies, which returned while the patient was in the ER, revealed a potassium of 7.8 mmol/L with a creatinine of 1.0 mg/dL. Her other labs were unremarkable