A 64-year-old woman comes to the emergency room complaining of tremors in all extremities, palpitations and confusion for the last 3 days. Her current medical history is significant for peptic ulcer disease, diabetes and bladder cancer. Her current medications include omeprazole for peptic ulcer disease, metformin for diabetes and cisplatin for bladder cancer. Review of systems is significant for occasional heart burns and daily loose bowel movements since she was started on metformin.She drinks three alcoholic drinks per day and smokes half a pack of cigarettes. On physical examination, tapping in front of the woman’s ears leads to ipsilateral facial muscle contracture. The inflation of a blood pressure cuff on her right arm leads to right-sided carpal spasm after 1 minute. She was admitted to the hospital. Laboratory findings show low calcium, low potassium, high phosphate and normal magnesium levels. ECG demonstrates widening of the QRS complex, peaked T waves, and prolonged PR interval. Despite repeated intravenous administrations of calcium and potassium, the patient’s hypocalcemia and hypokalemia have not been corrected. Which of the following is a risk factor for the disorder that is responsible for this patient’s emergency department visit today ?

A 64-year-old woman comes to the emergency room complaining of tremors in all extremities, palpitations and confusion for the last 3 days. Her current medical history is significant for peptic ulcer disease, diabetes and bladder cancer. Her current medications include omeprazole for peptic ulcer disease, metformin for diabetes and cisplatin for bladder cancer. Review of systems is significant for occasional heart burns and daily loose bowel movements since she was started on metformin.She drinks three alcoholic drinks per day and smokes half a pack of cigarettes. On physical examination, tapping in front of the woman’s ears leads to ipsilateral facial muscle contracture. The inflation of a blood pressure cuff on her right arm leads to right-sided carpal spasm after 1 minute. She was admitted to the hospital. Laboratory findings show low calcium, low potassium, high phosphate and normal magnesium levels. ECG demonstrates widening of the QRS complex, peaked T waves, and prolonged PR interval. Despite repeated intravenous administrations of calcium and potassium, the patient’s hypocalcemia and hypokalemia have not been corrected. Which of the following is the best explanation for the refractory hypocalcemia and hypokalemia in this patient?

Case: A 56-year-old man comes to the emergency room because he has developed nausea, vomiting, muscle cramps, and weakness for the last three days. Five days ago he started on potassium G for acute pharyngitis and he has been taking it regularly along with his other medications, lisinopril, atorvastatin and spironolactone. On a physical examination, you notice a middle-aged man, who is anxious and distressed. He has difficulty walking; has decreased sensations and decreased reflexes in all four extremities. Laboratory studies are notable for a potassium level of 6.8 mmol/L. An ECG was taken. Q.Which of the following medications can cause this disorder?

A 42-year-old woman is brought to the emergency department with confusion, nausea, and seizures. Her medical history includes small-cell lung cancer, and she has been on fluid-restrictive therapy due to suspected syndrome of inappropriate antidiuretic hormone secretion (SIADH). Laboratory tests reveal: Serum Sodium (Na⁺): 118 mM (Low) Serum Osmolality: 265 mOsm/kg (Hypotonic) Urine Osmolality: 500 mOsm/kg (Concentrated) Which of the following is the most appropriate initial treatment for this patient?