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Retired NBME Step 2 CK Free 120 Answers

step2ck_free120/Block 1/Question#5 (reveal difficulty score)
A 67-year-old man is brought to the emergency ...
Adverse effect of medications ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: Cardio

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submitted by โˆ—bwdc(697)
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Lisinopril and especially spironolactone (a K-sparing diuretic) can both cause hyperkalemia. Renal failure (severe AKI or ESRD) is also a major cause of hyperkalemia, but not in this case with the only mildly elevated Cr and BUN levels.

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yb_26  Looks like digoxin toxicity: nausea, malaise, weakness, hyperkalemia. Digoxin binds to Na-K ATPase at the same site as K. So when digoxin level is high, it occupies all receptors leading to hyperkalemia. Also vomiting and confusion may be seen in acute setting. Chronic digoxin toxicity is also associated with lethargy, disorientation, xanthopsia. +1
azibird  I agree that it seems like digoxin, would be curious for someone else to weigh in. Why the elevated Cr, BUN, low bicarb, and 2+ edema? Hyperkalemia alone can't cause that, digoxin toxicity can't cause that. Slowly developing CKD so slowly bumped his digoxin levels and lead to presentation? Or other diuretic interactions messing with things? +



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