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A 40 year old African Amercian male, with a history of diabetes, presented to the emergency department with persistent diarrhea over the past few months. Soon after arrival, the patient developed respiratory failure, requiring mechanical ventilation. Labs at the time of presentation revealed severe hypokalemia (K 1.0), metabolic acidosis (HCO3 10), prerenal azotemia (BUN 150, Cr 11) and marked hypoalbuminemia (Alb 1.0). IV hydration and electrolyte supplementation were initiated, he was soon extubated and he had a relatively uneventful hospital course. A non-contrast CT of the abdomen was normal and a colonic biopsy showed only nonspecific, mild inflammation.
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