title: Multiple Electrolyte and Metabolic Emergencies in a Single Patient.
abstract: While some electrolyte disturbances are immediately life-threatening and must be emergently treated, others may be delayed without immediate adverse consequences. We discuss a patient with alcoholism and diabetes mellitus type 2 who presented with volume depletion and multiple life-threatening electrolyte and metabolic derangements including severe hyponatremia (serum sodium concentration [SNa] 107 mEq/L), hypophosphatemia ("undetectable," <1.0 mg/dL), and hypokalemia (2.2 mEq/L), moderate diabetic ketoacidosis ([DKA], pH 7.21, serum anion gap [SAG] 37) and hypocalcemia (ionized calcium 4.0 mg/dL), mild hypomagnesemia (1.6 mg/dL), and electrocardiogram with prolonged QTc. Following two liters of normal saline and associated increase in SNaby 4 mEq/L and serum osmolality by 2.4 mosm/Kg, renal service was consulted. We were challenged with minimizing the correction of SNa(or effective serum osmolality) to avoid the osmotic demyelinating syndrome while replacing volume, potassium, phosphorus, calcium, and magnesium and concurrently treating DKA. Our management plan was further complicated by an episode of significant aquaresis. A stepwise approach was strategized to prioritize and correct all disturbances with considerations that the treatment of one condition could affect or directly worsen another. The current case demonstrates that a thorough understanding of electrolyte physiology is required in managing complex electrolyte disturbances to avoid disastrous outcomes.
authors.affiliation: Olive View-UCLA Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA.
authors.forename: Caprice
authors.initials: C
authors.lastname: Cadacio
authors.affiliation: Ronald Reagan UCLA Medical Center, 200 Medical Plaza, Los Angeles, CA 90095, USA.
authors.forename: Phuong-Thu
authors.initials: PT
authors.lastname: Pham
authors.affiliation: Olive View-UCLA Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Bhasin
authors.affiliation: Olive View-UCLA Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Kamarzarian
authors.affiliation: Olive View-UCLA Medical Center, 14445 Olive View Drive, 2B-182, Sylmar, CA 91342, USA.
authors.forename: Phuong-Chi
authors.identifier: 0000-0001-7418-1658
authors.initials: PC
authors.lastname: Pham