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The EBM note by Glasziou on hyperkalemia1 brought to mind my old bias dating back more than 50 years. A serum potassium of 7.3 mmol/l in an otherwise healthy individual does not fit the adage of a renal physician, “the first symptom of hyperkalaemia is death.” I am convinced that any serious effect of hyperkalaemia must result from the concentration of intracellular potassium, which we are still unable to measure clinically. One of the mechanisms of hyperkalaemia is the release of potassium from cells, certainly not a dangerous situation. Might the 62% sensitivity reported for electrocardiographic (ECG) changes suggest that 38% had no real increase in intracellular potassium? Was Dr. Glasziou’s patient wiser than the renal specialist when she refused to accept a doctor created emergency?
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