Multiple Electrolyte and Metabolic Emergencies in a Single Patient

Table 1

Clinical data.

Serum chemistry	Admission	After 2 L normal saline (renal service was consulted)	12 to 14 hours after admission	8 hours after insulin administration (30 to 32 hours after admission)	Discharge (12 days after admission)	Total amount replaced during hospitalization	Electrolyte concentrations of fluids administered
Sodium (mEq/L)	107	111	113	117	132	2 liters of normal saline at presentation	154 mEq/L
Potassium (mEq/L)	2.8	2.2	2.9 to 3.2	2.7	4.5	480 mEq KCl	100 mEq/L
Total (mEq/L)	12	11	6	14	25	Corrected with insulin
Serum anion gap (mEq/L)	37	31	30	19	10	Corrected with insulin	—
Glucose (mg/dL)	331	248	250	108	217	Corrected with insulin	—
Phosphorus (mg/dL)	Not done	<1.0	<1.0	<1.0	5.5	240 mmol KPO4	15 mmol mixed in 200 mL normal saline or free water as needed to achieve sodium correction goal
Total calcium (mg/dL)	7.2	6.9	6.8	6.8	8.4	4 g calcium gluconate (9.3 mmol)	10% solution
Ionized calcium (mg/dL) [normal 4.6–5.4]	4.1	Not done	4.0	Not done	Not done
Magnesium (mg/dL)	1.6	Not done	3.1	Not done	1.7	8 g	4 g mixed in 250 mL normal saline