Hyperkalemia after Missed Hemodialysis
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A 48-year-old man with a history of end-stage renal disease who had undergone parathyroidectomy owing to tertiary hyperparathyroidism 1 month earlier presented to the emergency department with weakness and diffuse muscle aches after missing a hemodialysis session. The laboratory analysis showed severe hyperkalemia (potassium level, 36.0 mg per deciliter [9.2 mmol per liter]; normal range, 14.0 to 19.9 mg per deciliter [3.6 to 5.1 mmol per liter]) and severe hypocalcemia (calcium level, 5.0 mg per deciliter [1.25 mmol per liter]; normal range, 8.4 to 10.3 mg per deciliter [2.10 to 2.58 mmol per liter]), with an ionized calcium level of 1.84 mg per deciliter (0.46 mmol per liter; normal range, 4.48 to 5.28 mg per deciliter [1.12 to 1.32 mmol per liter])....

http://www.nejm.org/doi/full/10.1056/NEJMicm1512236
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