A patient with Chronic Kidney Disease is most likely to develop which combination of electrolyte imbalances and acid-base disorder?

Appeared in: NORCET-11 Prelims

Explanation

CKD impairs excretion of acids, potassium, phosphate, and magnesium.
Metabolic acidosis develops due to acid retention.
Hyperkalemia, hyperphosphatemia, and hypermagnesemia are classic due to reduced renal clearance.

Option B: Hypokalemia, hypophosphatemia, and hypercalcemia are not typical in CKD. CKD usually causes retention, not loss, of potassium and phosphate. Hypercalcemia is rare and usually only occurs with excessive calcium or vitamin D therapy.
Option C: Hypernatremia and hypokalemia are not common in CKD. Sodium is usually retained but plasma sodium concentration often remains normal unless there is water imbalance. Hypokalemia is not expected; hyperkalemia is more typical.
Option D: Hyponatremia, hypokalemia, and hypophosphatemia are not the usual findings in CKD. CKD patients tend to retain potassium and phosphate, not lose them.

Clinical Relevance

Nursing practice connection: Use the key finding related to Electrolyte and acid-base disturbances in chronic kidney disease to guide bedside assessment, documentation, and the next nursing action.
Nurses must monitor CKD patients for signs of hyperkalemia (arrhythmias), hyperphosphatemia (bone disease), and metabolic acidosis (fatigue, confusion).
Early recognition and management of these imbalances can prevent life-threatening complications.
What if? If a CKD patient is given excessive calcium or vitamin D, hypercalcemia may develop, but this is not the typical pattern without supplementation.

How to Approach the Question

Identify the pathophysiology of CKD and its effect on excretion of acids and electrolytes.
Recall which electrolytes are retained versus lost in CKD.
Eliminate options that include hypokalemia, hypophosphatemia, or hypercalcemia, as these are not typical in CKD.
Select the option that matches the classic findings: metabolic acidosis, hyperkalemia, hyperphosphatemia, and hypermagnesemia.

Concept Tested & Keywords

Concept Tested: Electrolyte and acid-base disturbances in chronic kidney disease
Stem keywords: Chronic Kidney Disease, electrolyte imbalances, acid-base disorder
Lead-in keywords: most likely
Clinical cues: CKD causes retention of potassium, phosphate, magnesium, and acids

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E6 Medicine Harrison 22e Part 2 p. 294-296

Practise the full NORCET-11 Prelims

Attempt every question from this paper in a timed mock, then review the full solution for each one.