So the patient is linda mays foxtrot270 may 1945 80 year old lady did you pee I I received a call from the laboratory late in the evening of the august 5 yeah so I was phoned late in the evening of the august 5 by the laboratory regarding some blood tests that you took from this lady in the morning full stop I note from the gp record that she's currently being treated for infectious gastroenteritis with significant fluid losses and I also know her background of significant physiological frailty and that she lives in a nursing home I was able to review the excellently completed treatment escalation plan which is also very helpful so thank you for that full stop her potassium level came back as 2.3 with creatinine of a 174 and neutrophilia full stop this is indicative of an aki 1 full stop <\n\n> I discussed with claire the lasting power of attorney and daughter and we had a long frank discussion about the risks and benefits of hospital admission in order to resolve this hypokalemia full stop she is now aware that this profound hypokalemia can be very dangerous and lead to arrhythmia and death but also that a hospital admission to correct this would likely be prolonged and lead to a decrease in quality of life for the patient full stop <\n\n> After a long discussion we agreed that we would attempt to undertake treatment in the nursing home and not bring her to hospital full stop <\n\n> I discussed the nursing home who will try to deliver oral potassium replacement either with paramedics or from their own stores this evening but I'd be grateful if you could follow-up with her as soon as possible full stop <\n\n> I tried to send you this message using a qrx but unfortunately you don't use this service so it was so a letter is the only way I can get through to you full stop yours sincerely