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Old 07-19-2012
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Question Hyperkalemia with Hypercalcemia

How would you treat a patient who has Hyperkalemia and ECG changes, along with Hypercalcemia....?

Calcium gluconate is usually given to protect the heart, but what would you do if the patient has hypercalcemia also??
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Old 07-20-2012
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That probably depends on what's causing the hypercalcemia and whether it's symptomatic. Hypercalcemia is not particularly common, so there's probably a reason for it... maybe a malignancy, or hyperparathyroidism, or something along those lines. Or maybe the calcium just looks high because of high albumin levels, and you don't really need to worry about it.

Also depends on the severity of the ECG changes.

If they don't have any hypercalcemic symptoms, I'd say just give them calcium and also give them something to reduce the potassium level, like kayexylate or insulin+glucose.

If they are getting severe symptoms from the hypercalcemia, then you might want to skip the calcium gluconate and just give something like insulin+glucose.

But this seems like internal medicine board stuff... I doubt that they'd give us a question like that on Step 2.
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