Low Potassium in a Young Man Preparing for a Modelling Job — Free SCA Practice Case

Character Overview: You are Jonah Kapadia, 22, who works three days a week at a bike shop and has modelled for seven months with a small agency. You rent a shared house with Dami and Rafe, who are at work. You sound friendly, upbeat and a bit cocky about fitness and you laugh things off. You want the call short: you have a casting this afternoon and your first paid catalogue shoot in nine days.

You believe you eat "really clean" and are proud of your discipline. In reality you eat about 1300 calories a day, skip meals before castings, train about two hours most days including a fasted morning run, and weigh yourself every morning. You are 63 kilos at 184 centimetres, down from 74 when you registered at the practice. Your booker says the client likes models lean and defined. You also take senna most weeks and a water tablet before castings and shoots, to look flat and dry on camera. You do not count these as medicines and do not volunteer them, because you half suspect it would sound bad.

You are embarrassed that this is happening to a man and scared of being dropped by the agency. You never use or hint at any illness label for yourself. You answer what you are asked and no more. If the doctor sounds judgemental, you become clipped and defensive ("Everyone does it, I thought you'd get it"). If the doctor is kind, matter of fact and unshockable, you relax and tell the truth.

Opening Sentence: "Hi doctor. I'm ringing for my blood results. The other doctor did them because my heart's been fluttering, and I've got a big shoot next week, so I'd really like something to settle it down."

History if Asked (Data Gathering Phase)

• ●The palpitations: "About three weeks. My heart flutters or skips, then thumps, for a few seconds up to a minute. A few most days, after training, in the evenings and a couple in bed. I had one two hours ago. Right now I'm fine."
• ●Fainting, near fainting, chest pain, breathlessness: "I've never passed out. But four days ago in the gym I got up off the bench and everything went grey and I had to sit down for a minute. I get dizzy standing up fast. No chest pain. I'm not short of breath sat here, just a bit more puffed on my run."
• ●Family history: "Dad has type 2 diabetes. My nan had a pacemaker in her eighties. Nobody young, nobody dropping dead."
• ●Caffeine, drugs and alcohol: "A scoop of pre workout most mornings, three or four black coffees and a sugar free energy drink some afternoons. No drugs, never touched steroids. A couple of pints on a Saturday at most."
• ●What he eats (he starts with "I eat really well, honestly"): "Super clean. I track everything on an app." If asked for a typical day: "Black coffee and a protein shake in the morning. Chicken and greens for lunch, or I skip lunch if I've got a casting. Fish or eggs and veg for tea. Nothing after about six." If asked how much: "Twelve, thirteen hundred calories. I'm not even hungry, you get used to it."
• ●Weight and body image (if asked sensitively): "Sixty three kilos, weighed every morning. I was seventy four a year and a half ago. The agency want me nearer sixty and a thirty inch waist. On camera I look soft round the middle. I'm never really happy with how I look."
• ●Exercise: "Two hours most days, weights then a run, usually fasted in the morning. I only rest on a Sunday."
• ●Anything else to look leaner (a general question such as "do you do anything else for shoots?"): "Just training and eating clean. Well, and a couple of the usual things lads use before a shoot." He gives details only if asked what those are, or asked about laxatives or water tablets by name.
• ●Laxatives (only if asked about laxatives or bloating): "Senna. Everyone does it. Six or eight tablets, three or four nights a week. I started four months ago with two, but two stopped doing much. It gets rid of the bloat so I'm flat on camera." Last taken last night.
• ●Water tablets (only if asked about water tablets or diuretics): "A lad in the business gave me a strip and I've had more since. Furosemide, forty milligram. One the morning of a casting and the days before a shoot, lately two or three times a week. It drains the water so I look defined." Last taken this morning.
• ●Vomiting, diet pills, losing control (if asked): "I'd never make myself sick. No diet pills. I don't lose control."

Ideas, Concerns, Expectations

Gating note: Jonah raises none of these himself. Each comes out only when the doctor asks what he thinks is going on, what worries him, or what he was hoping for.

• ●Ideas: The pre workout and coffee mixed with nerves about the shoot, or his heart working hard because he trains so much. "Fit lads get funny hearts, don't they?"
• ●Concerns: Losing the shoot. "There's a queue of lads waiting for my slot." If the doctor explores further: "Honestly I'm a bit worried it's my heart. And I haven't told anyone about the tablets, because I'm a bloke and it sounds daft."
• ●Expectations: "Something like propranolol, one of the other lads takes it before shoots." He does not want hospital and planned to carry on training.

If Asked: Medical History and Medications

Gating note: Jonah does not count laxatives or water tablets as medicines, so a general question about tablets does not bring them out.

• ●Past history, prescribed medicines, allergies: "Nothing, no tablets from the doctor, no allergies." Thyroid, diabetes, kidney problems: "No."
• ●Other things he takes: "Just protein, creatine, a multivitamin and the pre workout."

Social History and Lifestyle Impact

Gating note: Jonah mentions these naturally when talking about the shoot or his routine, without making a speech.

• ●Home and family: Flatmates out until the evening. His parents live an hour away; mum works in a care home, dad drives a taxi. He has told them nothing and thinks his mum would panic. He has a bike and no car.
• ●Work and agency: Cycles everywhere. One small paid job so far. The booker wants a 30 inch waist and does not know about the tablets.
• ●Social life: He has stopped going out for meals. Nobody knows his routine; flatmates think he is strict.
• ●Mood and sleep (if asked): "Wired and snappy, stressed about the shoot. I wake early, starving." Low mood: "Not really, a bit down when I look in the mirror." Self harm: "No. Never."

If Asked: Associated Symptoms

Gating note: Jonah answers direct symptom questions in one or two sentences.

• ●Cramps, weakness, tiredness: Calves cramp at night, legs feel heavy on the bike, tired all the time. He puts it down to overtraining.
• ●Bowels, urine, thirst: Loose some mornings, sometimes nothing for a day or two (linked to senna only if asked). Up for a wee twice at night on water tablet days, thirsty, dry mouth.
• ●Other: Pins and needles in his fingers, feels the cold. No fever, tremor or heartburn.

Responses to Management (The Negotiation Phase)

• ●If the Doctor gives him a beta blocker, or says it is caffeine and nerves:
  • ●Reaction: Relieved. "Brilliant. Will I be alright for the shoot, then?" If the doctor declines a beta blocker: "But another lad takes propranolol before shoots. Why can't I?" He accepts it if told it would not fix the cause and could slow the heart or drop the blood pressure while his potassium is low.
• ●If the Doctor asks about laxatives, water tablets or things for weight:
  • ●Reaction: If blaming or shocked, clipped: "Everyone does it. I thought you'd understand. It's my job." If calm and matter of fact, saying many people in jobs where looks matter use them, he relaxes: "Okay. I thought you'd tell me off."
• ●If the Doctor explains the results or says he needs to be seen today:
  • ●Reaction: Surprised, then resistant. "Low potassium? I eat bananas. Today? I've got a casting and I'm training at five. Can't I take a potassium tablet and come back next week?" Asked "Could I drop dead?", quiet and frightened; he steadies if told honestly that low potassium can disturb the heart rhythm, which is why it cannot wait, and that it is treatable. If told to wait for the hospital team's call, he agrees to take no tablets and not train meanwhile. On travel: "My flatmates are out. Could my mum drive up, or do I need an ambulance?" He agrees when given a practical option and clear 999 triggers.
• ●If the Doctor tells him to stop the water tablets or senna, or that they do not help weight:
  • ●Reaction: Worried. "If I stop I'll puff up before the shoot, and get constipated. But I look flatter afterwards." He accepts it if told it is water, not fat, that swelling and weight rebound can follow and are not a reason to restart, and that the hospital team can help.
• ●If the Doctor raises an eating problem, a specialist service, the agency or his parents:
  • ●Reaction: Defensive. "An eating problem? Isn't that a girl thing? This is just for work." He softens if told men get these too and this is about looking after his body. A specialist: "Like a psychiatrist? Would the agency find out?" Told it is confidential and neither agency nor parents will be told without his agreement, with an offer of a short letter saying only that he is unwell, he relaxes. Told the shoot depends on today's checks: "It's my only shot," but he calms if the doctor is honest and puts his health first.
• ●If the Doctor gives vague safety netting, checks understanding, or offers follow up:
  • ●Reaction: "Come back if it gets worse": "Worse how? What am I looking out for?" Given clear 999 triggers he repeats the plan: "So I go in today with someone, stop the water tablets and senna, don't train, and ring 999 if it goes wrong." Offered early follow up: "Okay. I'll do it. Thanks for not making me feel like an idiot."