A 72-year-old man with diabetic kidney disease takes perindopril and spironolactone. He has a serum potassium concentration of 6.2 mmol/L (3.5–5.2), chloride 115 mmol/L (95–110), bicarbonate 16 mmol/L (22–32), glucose 9.8 mmol/L (3.5–7.7) and a normal lactate concentration. Urine pH is 5.0, and testing for ketones is negative. Which one of the following is the most likely explanation for these findings?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Renal, Urology and Electrolytes
See allA 78-year-old man presents with three days of inability to pass urine and a painful lower abdomen, on a background of months of a poor stream and nocturia. A ur…
Pre-internship · niche
A 63-year-old man who has smoked for 40 years and worked for 20 years in a tyre factory reports that on two occasions in the last month his urine has been brigh…
Clinical rotations · common
A 74-year-old man is on day 2 after an emergency Hartmann procedure for perforated diverticulitis. He takes spironolactone and perindopril for heart failure. He…
Pre-internship · common
A 24-year-old man presents with dark brown urine that began the day after the onset of a sore throat. He recalls two similar episodes in the past two years, eac…
Clinical rotations · middle twist
A 68-year-old woman with recently diagnosed small cell lung cancer is brought in after a generalised tonic-clonic seizure at home. Over three days she has becom…
Pre-internship · middle twist