ESRD patient in the ER after missed dialysis: interpret the labs and ECG

Same patient: a 58-year-old man on hemodialysis who missed his last two sessions and has weakness, palpitations and fluid overload. He passes almost no urine. Interpret the results and outline your management.

Basic metabolic panel: K 7.1 mEq/L (3.5-5.0), Na 131 mEq/L (135-145), HCO3 14 mEq/L (22-28), urea and creatinine markedly raised, glucose normal. ABG: pH 7.27.

ECG: sinus rhythm, rate 62/min. Tall, peaked T waves in the precordial leads. PR interval prolonged (240 ms), P waves flattened, QRS widened (140 ms).