Severe life threatening hypokalaemia in a patient with an eating disorder.
1. Describe and Interpret:
Hyperchloraemic non anion gap metabolic acidosis
HCO3 16
AG 16
CL high
Severe hypokalaemia
Rhabdomyolysis
Interpretation –
RTA with severe hypokalaemia causing Rhabdomyolysis (look for other causes of Rhabdo)
Potassium plays a major role in regulating the skeletal muscle blood flow; an increased potassium concentration in the muscle during muscle activity causes vasodilatation, which increases the regional blood flow. In state of hypokalemia, this increase is hampered causing relative ischemia in the active muscle consecutively leading to muscle cramps, and in a severely depleted state may cause muscle necrosis and rhabdomyolysis. In addition to hypoperfusion, hypokalemia-induced impairment in muscle metabolism also may contribute to muscle dysfunction.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109789/?report=printable
2. Treatment
HDU/ICU admission
ivi fluids
replace K
monitor urine output
treat pain