Diagnostic Overlap Between Uremia and Severe Hyperkalemia in Chronic Kidney Disease: Emphasizing Laboratory-Guided Urgency Despite Absent EKG Changes

Hyperkalemia is a potentially life-threatening electrolyte disturbance often associated with characteristic electrocardiographic (EKG) changes and neuromuscular manifestations. However, clinical presentation does not always correlate with biochemical severity. We present the case of a 53-year-old female with chronic kidney disease (CKD) who developed acute-on-chronic kidney injury with severe hyperkalemia (serum potassium 8.7 mmol/L) and elevated urea (94 mg/dL), yet without EKG abnormalities or overt symptoms. The patient reported persistent nausea for 24 hours without abdominal pain or hemodynamic instability. Urgent hemodialysis was initiated due to critically elevated potassium. Post-dialysis, potassium normalized to 5.6 mmol/L, urea improved, and nausea resolved within one to two hours, suggesting a possible association between hyperkalemia and the presenting symptoms. This case highlights the diagnostic overlap between uremia and severe hyperkalemia and underscores the importance of laboratory-driven urgency in CKD patients, as significant hyperkalemia may be present despite minimal symptoms and normal EKG findings.