Dissolved

A 14 year old boy presents with nausea, vomiting and malaise for 2 days. There was no history of fever or system specific symptoms.

His medical history is significant for mild intermittent asthma since age 8. He visited his primary care practitioner 5 days ago with an exacerbation, which was treated with oral prednisolone for 3 days.

A FBC is within normal limits, but a serum electrolyte assay reveals a potassium level of 6.0 mEq/L; this is repeated and re-confirmed.

An ECG is found to be completely normal. His random capillary glucose is 120 mg/dl.

Select Relevant Investigations
Renal Functions + Urinalysis

Performed

Urea: 25 mg/dL (7 - 30)
Creatinine: 0.7 mg/dL (<1.2)
eGFR (Schwartz): 94.4 ml/min/1.73 m2
Urinalysis: no abnormalities
Arterial Blood Gases

Performed

pH: 7.38 (7.35 - 7.45)
paCO2: 40 mmHg (35 - 45)
paO2: 90 (> 75 on room air)
HCO3: 23 mmol/L (22 - 26)
ABE: -1.7 (-2 to +2)
Ca++, PO4---, Uric Acid

Performed

Ca++: 6.0 mg/dl (8.5 - 10.3)
PO4---: 8.2 mg/dl (3.5 - 5)
Uric Acid: 15 mg/dl (4.0 - 8.5)
CPK

Performed

CPK: 30 U/L (22 - 198)

Select Relevant Management
Nebulize with Salbutamol
Rasburicase
Calcium Gluconate
High-Dose Corticosteroids