APRT Deficiency DHA Stones — ESENeph MCQ

Correct answer: B — Stop potassium, review medicines and begin urgent potassium-lowering assessment

The best answer is “Stop potassium, review medicines and begin urgent potassium-lowering assessment”. The combination creates both impaired excretion and added potassium load. Immediate medication correction and severity-based potassium shifting or removal are required even before ECG changes appear. “Continue potassium supplements while arranging same-day repeat biochemistry” is less appropriate because CKD, RAS blockade and exogenous potassium combine to reduce safety margin “Increase ramipril while arranging urgent potassium-lowering treatment” is less appropriate because greater RAS blockade can further suppress aldosterone-mediated potassium secretion “Repeat potassium promptly while withholding exogenous potassium” is less appropriate because a confirmed value above 6 mmol/L requires prompt assessment and treatment “Give intravenous calcium while arranging definitive potassium-lowering treatment” is less appropriate because calcium does not lower potassium and is reserved for ECG toxicity or specific high-risk circumstances

Reference: UK Kidney Association hyperkalaemia guideline: https://guidelines.ukkidney.org/hyperkalaemia/