An 81 year old gentleman was struggling with CHF symtpoms. Fluid overload was the problem with difficulty breathing secondary to increased edema/CHF symptoms. His Lasix was increased from 20 mg daily up to 40 mg daily to help promote the loss of fluid. Three days later, the increase in Lasix did not have a great enough effect and Zaroxolyn 5 mg daily was added to augment the fluid loss. The provider did order a follow up BMP (which would contain electrolytes and creatinine) for two weeks from the Zaroxolyn Rx.
The baseline potassium level was about 3.5 to 3.7 prior to the increase in Lasix and addition of Zaroxolyn. At the two week check, the potassium was down to a critical low of 2.4. This case is just a simple reminder that there is a reason why lab monitoring is necessary, and patients can run into serious problems very quickly if not kept a close eye on especially when significant changes are made. Dosing and frequency of these changes can make a huge difference in how aggressive we get in lab monitoring.
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