A 65-year-old man with CKD stage 4 and newly diagnosed HF with reduced ejection fraction (NYHA class III) is initiated on guideline-directed pharmacotherapy, including a beta-blocker and ACEI. His baseline serum K+ level is 4.3 mEq/L. Two weeks after starting therapy his serum K+ is 4.8 mEq/L, and spironolactone 25 mg daily is added for mortality benefit. His serum K+ level 1 week after being on dual RAASi therapy is 5.3 mEq/L.
A 65-year-old man with CKD stage 4 and newly diagnosed HF with reduced ejection fraction (NYHA class III) is initiated on guideline-directed pharmacotherapy, including a beta-blocker and ACEI. His baseline serum K+ level is 4.3 mEq/L. Two weeks after starting therapy his serum K+ is 4.8 mEq/L, and spironolactone 25 mg daily is added for mortality benefit. His serum K+ level 1 week after being on dual RAASi therapy is 5.3 mEq/L.
A potassium binding resin is started, and 1 week later the patient’s serum K+ is 5.6 mEq/L. An electrocardiogram is normal, but the patient is complaining of muscle aches in his bilateral lower extremities.