Mrs. Sharma, a 67-year-old female admitted with heart failure, is being treated with aspirin, frusemide, and dobutamine infusion. On the first day of hospitalization she passed 2400 ml of urine, indicating significant diuresis. Subsequently, she developed fatigue, refusal to eat, abdominal distention with paralytic ileus, and laboratory findings revealed severe hypokalemia with a serum potassium level of 2.7 mEq/L. In a geriatric patient, such electrolyte imbalance can have serious systemic consequences, and prompt, comprehensive management is required. The primary problem in this case is hypokalemia, most likely induced by frusemide, a loop diuretic that increases renal excretion of potassium. Excessive diuresis in elderly patients can rapidly deplete potassium stores. Dobutamine may also contribute indirectly by increasing renal perfusion and urine output. Hypokalemia explains her fatigue, anorexia, and paralytic ileus. In older adults, even moderate electrolyte imbalance can manifest with significant gastrointestinal and neuromuscular symptoms. The immediate management involves correction of hypokalemia. Since her serum potassium is 2.7 mEq/L, which is moderately to severely low, potassium replacement therapy should be initiated promptly. If the patient is unable to tolerate oral intake due to ileus and anorexia, intravenous potassium chloride should be administered cautiously. In elderly patients with heart failure, intravenous potassium is generally given at a rate not exceeding 10–20 mEq per hour under continuous cardiac monitoring. Rapid infusion can precipitate cardiac arrhythmias. Electrocardiogram monitoring is essential, as hypokalemia may cause U waves, ST depression, and predispose to ventricular arrhythmias. Once gastrointestinal function improves, oral potassium supplementation should be continued. Potassium chloride syrup or tablets may be given in divided doses to restore total body potassium deficit.