A 59-year-old female with past medical history of hypertension, type 2 diabetes mellitus, end-stage renal disease (ESRD) on hemodialysis (HD) presented to the emergency department (ED) with a request for routine HD (note: Cook County Hospital has a cohort of patients who routinely receive their HD via the emergency department rather than through an outpatient clinic). Initial vital signs were notable for hypertension but were otherwise unremarkable. The patient denied any symptoms, but reported that her last HD session was more than a week ago. The Renal service was consulted for HD and recommended obtaining labs given her missed HD sessions. The potassium level returned at 8.7 (not hemolyzed).

Alexandra Atkins, MD and Ari Edelheit, MD