Table 2. Differential diagnosis of severe hyperkalemia in the present case.

Possible cause	Findings in the present case	Interpretation
Acute kidney injury	Cr 0.85 → 1.3 mg/dL	Unlikely as the sole cause
Rhabdomyolysis	CK 77 → 96 U/L	Unlikely
Drug-induced hyperkalemia	Spironolactone (25 mg/day)	Unlikely as the sole cause
Pseudohyperkalemia	No hemolysis reported; no marked thrombocytosis/leukocytosis	Unlikely
Ischemia–reperfusion injury	Temporal relationship, CT findings, ECG progression	Most plausible

The proposed mechanism of ischemia–reperfusion injury is based on the overall clinical and imaging findings rather than pathological confirmation.

CK, creatine kinase; Cr, creatinine; ECG, electrocardiogram