1. Dr Pir Shah The last time I had my renal function it was fine I am not so sure about my Liver Function Test!

2. History 74 year old patient presented in a Residential home. Lethargy, short of breath overnight,palpitations last less than 30 seconds that resolved spontaneously. No chest pain/no dib No infective history Bowels opening and no urinary symptoms

3. History PMH: Type II diabetes Hypertension Hypercholesterolemia Chronic renal impairment Left sided ischaemic diabetic maculopathy Right background diabetic retinopathy Previous CA breast Beta-thalassaemia trait. Hyperkalaemia

4. History DH: Omeprazole 20mg OD Paracetamol 1g QDS Simvastatin 40mg nocte Frusemide 20mg OD Codeine 30mg QDS Mixtard 30 Temazepam 20mg nocte Sertraline 50mg OD Capsaicin cream 0.025%

5. Observation: Afebrile 84 bpm sinus BP: 136/80 Rr 16

6. Examination Pt was seated, alert, well perfused periphery. no sunken eyes, good palor, generally weak, felt light-headed. CV: heart sounds normal Res: airway entry was fine and no added sounds GI: sft, non tender.

7. Examination Neurology: CNII-XII, no focal neurology noted. Need to rule out NO NOT A UTI 1. Anaemia 2. U+E imbalance

8. Examination Plan 1. bloods 2. urine dipstick 3. Glucose dipstick

9. Potassium K+ Urea Creatinine eGFR 6.3mmol/L 13.5mmol/L 118umol/L 40mL/min 5.5mmol/L 14.3mmol/L 125umol/L 37mL/min 6.5mmol/L 10.8mmol/L 113umol/L 42mL/min

10. Examination Potassium 6.5 Pt was at Derby in the renal clinic talked to the nurse running the clinic and one of the registrars that was in clinic and made them aware of the Potassium.

11. Potassium Potassium, the most abundant intracellular cation. Potassium is obtained through the diet. Common potassium-rich foods include meats, beans, fruits, and potatoes. Gastrointestinal absorption is complete, resulting in daily excess intake of about 1 mEq/kg/d (60-100 mEq). Excess is excreted through the kidneys (90%) and the gut (10%). Potassium homeostasis is maintained predominantly through the regulation of renal excretion. The most important site of regulation is the distal nephron, including the distal convoluted tubule, the connecting tubule, and the cortical collecting tubule, where aldosterone receptors are present.

12. Potassium Potassium, the most abundant intracellular cation. Potassium is obtained through the diet. Common potassium-rich foods include meats, beans, fruits, and potatoes. Gastrointestinal absorption is complete, resulting in daily excess intake of about 1 mEq/kg/d (60-100 mEq). Excess is excreted through the kidneys (90%) and the gut (10%). Potassium homeostasis is maintained predominantly through the regulation of renal excretion. The most important site of regulation is the distal nephron, including the distal convoluted tubule, the connecting tubule, and the cortical collecting tubule, where aldosterone receptors are present.

13. Potassium K intake is closely related to meat, vegetable, and fruit ingestion and usually does not require adjustment. However, foods (especially salt substitutes) rich in K should generally be avoided. Hyperkalemia is infrequent until end-stage renal failure, when intake may need to be restricted to ≤ 50 mmol/day. Mild hyperkalemia ( 6 mmol/L) warrants urgent treatment.

14. Happy itching….