Correct!
4. Both 2 and 3
Metabolic abnormalities such as hypokalemia, hypocalcemia, and hypomagnesemia, are common and occur in more than 50% of patients (2). Hypokalemia may be due to a secretory diarrhea with high potassium content. The proposed mechanism for this is up regulation of apical big potassium (BK) channels throughout the surface-crypt axes of the colon (12). Colonic BK channels play a significant role in intestinal potassium secretion in a variety of disease processes (13). The main purpose of treating hypokalemia is to prevent life-threatening complications, such as arrhythmias, paralysis, rhabdomyolysis, and diaphragmatic weakness. Several forms of potassium repletion exist. Estimating the potassium deficit assumes that there is a normal distribution of potassium between the intracellular and the extracellular space. The preferred replacement form is potassium chloride because patients with hypokalemia and metabolic alkalosis are often chloride depleted. In addition, potassium chloride raises the serum chloride at a much faster rate than potassium bicarbonate.
Case continued:
He became progressively hypoxemic and a chest x-ray was obtained prior to his transfer to the intensive care unit (Figure 3).
Figure 3. Panel A: Most recent AP film (four days after presentation). Panel B: AP film on admission.
What is the most significant change noted on the chest X-ray that can account for his progressive hypoxemia? (Click on the correct answer to proceed to the next panel)