Long-standing Type 2 Diabetes in Medicine / Internal Medicine — 62yo Man | Nephrology | SMLE Q#16504
SMLE Question #16504
Medicine / Internal Medicine
Nephrology
Objective: OBJ-188
Last updated: February 2026
A 62-year-old man with long-standing type 2 diabetes mellitus and resistant hypertension has newly diagnosed high-grade lymphoma and is scheduled to start chemotherapy next week. His medications are lisinopril, insulin, and spironolactone (started 3 months ago). He has no known kidney disease. He is found collapsed at home; paramedics achieve return of spontaneous circulation. In the emergency department, initial blood tests show severe hyperkalemia and acute kidney injury without metabolic acidosis. Which of the following is the most likely cause of his severe hyperkalemia?
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