A 60-year-old man entered the emergency room department after 2 days of “not fee

Question

A 60-year-old man entered the emergency room department after 2 days of “not feeling so well.” Patient history revealed a myocardial infarction 5 years ago, when he was prescribed Digoxin. Two years ago, he was prescribed a diuretic after periodic bouts of edema. An ECG performed at the time of admission indicated the presence of cardiac arrhythmia. Chemistry testing performed on admission showed the following results:

Analyte

Result

Digoxin

1.4 ng/mL

(therapeutic range 0.5-2.2 ng/mL)

Na+

137 mmol/L

K+

2.5 mmol/L

Cl-

100 mmol/L

HCO3-

25 mmol/L

Mg2+

0.4 mmol/L

Ionized Calcium

1.0 mmol/L

Which results are abnormal? For each abnormal result, determine if it is high or low compared to the reference ranges discussed in lecture.

The Digoxin level is within the recommended therapeutic range. The Digoxin results mean that the arrhythmia is not likely due to the patient’s history of myocardial infarction, so what might be causing the patient’s arrhythmia?

How could this patient be treated?

Analyte

Result

Digoxin

1.4 ng/mL

(therapeutic range 0.5-2.2 ng/mL)

Na+

137 mmol/L

K+

2.5 mmol/L

Cl-

100 mmol/L

HCO3-

25 mmol/L

Mg2+

0.4 mmol/L

Ionized Calcium

1.0 mmol/L

Explanation / Answer

The potassium levels are lower known as Hypokalemia. (Normal K+ levels are between 3.5 and 5.0 mmol/L) .

Also the low level of ionised Calcium, which might be due to Digoxin medication.

The possible cause of arrthymia might be due to hypokalemia

Management of Hypokalemia

1.Oral Kcl can be administered to replenish the K+ depletion.

2.Potassium-sparing diuretics may be administered.

3. ACE inhibitors can be given since the patient has a renal history.

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