Chapter 4: The Real Danger Revealed

At this time, the resident came to report that the patient's blood test results were out—nothing much, except that potassium was extremely low, only 1.8 mmol/L (normal range: 3.5–5.5).

He looked up from the screen, eyes wide, “Sir, potassium bahut kam hai—1.8!” Even I felt a jolt of alarm.

This was within my expectations—1.8 is extremely severe hypokalemia.

Anything below 3.0 is bad; 1.8 is a red alert—like a petrol tank running on fumes, car liable to stall any moment.

What's the cause? I asked the resident.

He stammered, “Sir... maybe because of malnutrition? She hasn’t eaten much.”

Probably because the patient had poor appetite and ate little, the resident answered, very by-the-book.

His answer was textbook, but I still wondered—could there be another cause? Hidden losses, medicines?

That was the most obvious reason for now. After all, the family said she hadn't eaten much lately.

I nodded, but made a mental note to check for any diuretic use, vomiting, diarrhoea—anything that could explain such a severe drop.

The resident's analysis was correct, at least for now. We prescribed potassium chloride for the patient.

I wrote the order—IV potassium, slow drip. The nurse double-checked the dosage, as the risk of over-correction is just as dangerous.

We had to quickly bring her potassium up to a safe level—1.8 mmol/L is dangerously low, she could easily go into cardiac arrest.

I explained to Arjun, “Dekhiye, agar potassium bahut kam ho gaya toh heart band ho sakta hai. Isliye jaldi se sahi karna padega.”

Potassium and sodium ions are essential for heart cell function—too high or too low potassium affects the heart's electrical activity and can cause arrhythmias.

“Ye jo dil ka current hai na, potassium se chalta hai. Kam hua toh, short circuit ho sakta hai,” I added, hoping he’d understand.

Severe hypokalemia can cause cardiac arrest. Just a few months ago, there was a news story about a patient who died the night after surgery—autopsy showed severe hypokalemia.

I remembered that article in the Indian Express—one more lesson in humility for doctors everywhere. I recounted the story to the resident as a warning.

I told the resident about the dangers of hypokalemia—these are lessons written in blood.

He nodded solemnly, making notes. “Kabhi bhi potassium miss mat karna, samjha?”

Also, the patient's seizure might be related to hypokalemia—quickly correct the potassium.

This fit could easily be from the low potassium, not just the brain. We had to act fast.

Since admission, the patient hadn't had an ECG—must do one, I told the resident.

“ECG lagao jaldi se,” I said. With hypokalemia, the heart’s rhythm can go haywire. We had to check now.

With such low potassium, checking the ECG is essential; the resident could also learn the ECG features of hypokalemia.

This was a teaching moment—flattened T waves, prominent U waves. The resident’s eyes lit up—practical medicine in action.

The resident was excited and went off to wheel over the ECG machine.

He rushed away, almost tripping on the IV stand, the eager energy of a new doctor on the front lines.

When connecting the ECG electrodes, you need to roll up the patient's pant leg. When the resident did this, it caught my attention.

I watched from the side, noting the way Meera’s ankle looked—something odd about the skin there, maybe a scar or swelling?

After rolling up the pant leg, the resident frowned, seemed about to say something, but held back, then glanced at me.

He hesitated, eyes flicking to mine, waiting for me to notice what he’d seen.

I was also watching from the side and saw everything.

Nothing escapes a doctor’s eye—every small sign, every unusual mark. I waited for him to speak up, but decided to guide him gently.

I smiled at him, nodding towards Meera’s leg. “Dekho beta, patient ki pair... always look for the clues others miss.”

But as I looked at Meera’s silent form, something told me this was only the beginning.