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The first symptom of hyperkalaemia is death
  1. John R de Palma, MD, FACP1
  1. 1Hemodialysis, Inc
 Santa Monica, California, USA

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    A repeated serum potassium value of 7.3 mEq/l in the US would cause the patient to be immediately transported to an emergency room (ER) and given top priority by the ER staff and physicians. The author did not repeat the serum potassium immediately. Why? He then indirectly indicates that this patient was seen in an office, “she was booked to see me,” a second serious error. Finally, death is not the first sign, symptom, or finding of hyperkalaemia.

    The belated second blood test confirmed hyperkalaemia. Severe hyperkalaemia on repeated blood testing will give almost exactly the same result (the accuracy of a serum potassium can be within 0.2 mEq/l per standard deviation), factitious causes of hyperkalaemia excluded. Were they?

    Another physician should be immediately sought. Did the author do this or consult a standard reference book on medicine on how to diagnose, then treat, hyperkalaemia? If the author had queried a knowledgeable nephrologist, he would have been told: (a) the most common symptom of hyperkalaemia is muscular weakness, not death; (b) we have seen extremity numbness and occasionally tingling, an irregular heartbeat perceived by the patient, and most alarming, a vague sense of doom; (c) was the body temperature less than normal? (hypothermia is common); and (d) a non-diagnostic …

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