In the latest of a new monthly series, our clinical adviser Dr Keith Hopcroft is asking readers to guess what abnormality was shown on the blood tests of a 73-year-old man with stage 3 CKD. Submit your answers below the line!
You see a 73-year-old man for a follow-up appointment. He was previously seen by a locum who arranged an array of bloods, urine tests and an ECG after the patient had recently been diagnosed with hypertension. He is now on amlodipine and his blood pressure is well controlled. He has no symptoms and in particular no chest pain or breathlessness, and has no significant past medical history at all. Other than his amlodipine, he is not on any other medication.
His dipstick urinalysis and ACR are normal. His blood tests reveal stage 3 CKD (confirmed subsequently on repeat, and stable), and cholesterol levels that justify initiation of a statin (indicated anyway in view of his CKD). It also shows one other abnormality.
His ECG is shown below:
The computer printout states, ‘Inferior infarct, age undetermined, prolonged QT, abnormal ECG’. It clearly shows flattened T waves throughout.
Five months later, he is reviewed and is still well, with normal blood pressure and managing fine on his treatment. The previous abnormality on his blood has been dealt with and his ECG is repeated (see below).
The ECG is now reported as normal and the previous changes – in particular the flattened T waves – have resolved.
What was the ‘one other abnormality’ that his original bloods showed that has now been ‘dealt with’? Give your answer below the line!
TSH/T4
low K+
Low k
low K+ ; but there does not appear to be any cause for this?
Treated muxoedema