Profound Hyperkalemia and Anemia in a Dialysis Patient With a Gastrointestinal Bleed

An 80-year-old male receiving dialysis three times per week presented to the emergency room with general malaise after missing four consecutive dialysis appointments. During his workup, he was noted to have a potassium of 9.1 mmol/L, hemoglobin of 4.1 g/dL, and an electrocardiogram showing a first-degree atrioventricular (AV) block, a right bundle branch block, peaked T waves, and a wide QRS complex. During emergent dialysis and resuscitation, the patient suffered respiratory failure and was intubated. The next morning, he underwent an esophagogastroduodenoscopy (EGD), which found a healing duodenal ulcer. He was extubated the same day and was discharged in stable condition a few days later. This case appears to report the highest observed potassium coupled with significant anemia in a patient not affected by cardiac arrest.