A 60-year-old man with a history of type 2 diabetes and hypertension presents for follow-up. His lab results show serum creatinine 1.8 mg/dL (baseline 1.0 mg/dL), BUN 35 mg/dL, potassium 6.2 mEq/L, and bicarbonate 18 mEq/L. He is currently on lisinopril and spironolactone. What is the most appropriate initial step in managing his hyperkalemia?

The correct answer to the question "A 60-year-old man with a history of type 2 diabetes and hypertension presents for follow-up. His lab results show serum creatinine 1.8 mg/dL (baseline 1.0 mg/dL), BUN 35 mg/dL, potassium 6.2 mEq/L, and bicarbonate 18 mEq/L. He is currently on lisinopril and spironolactone. What is the most appropriate initial step in managing his hyperkalemia?" is Option B: Discontinue spironolactone.

The other options — A) Administer intravenous insulin and glucose, C) Give calcium gluconate, D) Start sodium polystyrene sulfonate — are incorrect for this USMLE Exam Prep question. As explained above: This patient has hyperkalemia likely exacerbated by spironolactone, a potassium-sparing diuretic, and possibly lisinopril. While severe hyperkalemia might require acute treatment, discontinuing the o…