Electropenia

I had the amazing electropenia patient tonight. Yea, I know it’s not a real word but the patient was real. I don’t know what else to call her. A 79-year old female who came in by ambulance with a complaint of feeling weak. When she was laid on the sheet, you could hardly tell the sheet from the patient. It was a major feat just to get the lady to sit up for twenty seconds. Physical exam was unremarkable. Labs were drawn and results as follows:

Potassium                  2.3

Magnesium                0.7

Calcium                      5.1

Phosphorus               0.4

Hemoglobin               10.1

Hematocrit                 34

I said we needed to start some KCL and the ER doc agreed. I ordered 20 mEq over 2 hours, repeat X1, with 2 cc 1% lidocaine in 100 ml NS. The ER doc was pissed.  Why are you doing that, he asked. Well, because KCL burns like hell and the lidocaine will help numb the vein, and the lady is nauseated and will probably vomit any KCL given by mouth. No, don’t do that. Give her 40 mEq in 1000 cc NS at 200 an hour, and 50 mEq PO. Can she handle 200 an hour he asked. Probably, but I am really not sure.

I called the Cigna Hospitalist to get the patient admitted to the hospital. Get cardiac enzymes I was told. Which came back normal.

I called the Cigna guy back and went through the entire patient’s history. After I finished he said, send her home.

Ok, this lady can’t even sit up how can I send her home.

Well, err, uhh, maybe we should admit her.

Right, I responded.

Just get some KCL started, and some Mag. I told him I had the KCL going at 200 cc/hr and she had vomited the 50 mEq the doctor had ordered PO. I will add 4 gms Mag to the liter.

Ok, just send her to tele.

Right.

Thank you Doctor.

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