I came cross to that question and really can't further figure out the consecutive mechanism, I would appreciate if somebody could share a knowledge:

A 68-year-old man with long-standing hypertension and diabetes with secondary kidney disease presents to the clinic with gastrointestinal symptoms and watery diarrhea for 24 hours. His vital signs are within the normal range. His serum pH is 7.36 and bicarbonate is 19 mEq/L. His serum potassium is also elevated at 5.8 mEq/L, and all other electrolytes are normal.

Which of the following is the most appropriate next step in the management of his hyperkalemia?


Right answer was Administer Furosemide = I understand the part Furosemide wastes Na, K, Ca, Mg, Cl but what's the mechanism of cause of Hyperkalemia ( I also realize Insulin deficiency => shifts intracellular K out into bloodstream 2) Diarrhea => non-anion gap metab. acidosis => hyperventilation as an instant adaptation ( so there is low HCO3 ) ....

Can somebody help me to connect the dots....

Hi, thank you for Q. Firstly, I write this out my step 1 knowledge,
Without knowing protocols (probably needed to answer):

I would say in addition to all you rightly pointed out,
don't forget exchange between H+ and K+ in all of the cells.
That is the way, plasma can get rid of extra K+ To normalize
pH. I don't know why furosemide is recommended since
there are options like Ca++ gluconate, Insulin, Beta2 agonist,
Keyexalate and finally dialysis for K+ over 7. May be we
Should know the Ranal function tests and heart status?!
Furosemide is the strongest diuretic and can be given for
Metabolic acidosis and hyper K+. This patient is probably
in renal failure and risk of hypervolemia, acidosis, cardiac arrest
encephalopathy (High NH3).
By the way, this question sounds step 2 rather step 1. May I ask where
you saw it?