Interactive diabetes case 15: A 74-year-old patient with type 2 diabetes and recurrent hyperkalemia – A4

ANSWER — Incorrect.

It is possible that the patient has hyperkalemia due to hyporeninemic hypoaldosteronism (type 4 renal tubular acidosis [RTA]), but this is in part a diagnosis by exclusion and difficult to establish as the cause of hyperkalemia in the setting of impaired kidney function. While it is possible that the patient will need fludrocortisone as a mineralocorticoid replacement therapy for aldosterone deficiency, other possible explanations must be addressed. In a patient with diabetes and hyperglycemia, the possibility of hyperglycemia-induced hyperkalemia must always be considered. The immediate issue is to reduce the serum potassium level promptly. If this diagnosis is correct, then the potassium level should fall with administration of insulin and correction of the hyperglycemia. Long-term management of the diabetes and dietary issues can then be addressed.

The patient does not consume orange juice, bananas, or dried fruits, so advising her to eliminate these items from the diet would have no effect on the serum potassium level.

The source of the high potassium in a patient's diet is not always evident immediately and requires a detailed review of the diet. It is important to provide the patient with specific instructions based on this review and written material about the content of potassium in various foods (table 1).

Return to the beginning to try again. (See "Interactive diabetes case 15: A 74-year-old patient with type 2 diabetes and recurrent hyperkalemia".)