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Hyperkalaemia-induced Arrhythmia — EECC MCQ

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EasyArrhythmia & ElectrophysiologyHyperkalaemia-induced ArrhythmiaEECC

A 58-year-old man is admitted with palpitations and weakness. ECG shows a regular broad-complex tachycardia at 180 bpm with peaked T waves. Blood tests reveal potassium of 7.8 mmol/L, urea 35 mmol/L, and creatinine 680 micromol/L. What is the most important immediate intervention?

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Correct answer: A — Intravenous calcium gluconate 10% (30 mL)

Severe hyperkalaemia (>6.5 mmol/L) with ECG changes (peaked T waves, broad QRS, potentially a sine wave pattern) is a cardiac emergency. The most important immediate intervention is intravenous calcium gluconate (or calcium chloride via central line), which stabilises the myocardial membrane within minutes and protects against arrhythmias. It does not lower potassium but provides cardioprotection while other potassium-lowering measures (insulin-dextrose, salbutamol, sodium bicarbonate, calcium resonium, haemodialysis) take effect. Amiodarone would not address the underlying metabolic cause. Emergency dialysis is the definitive treatment but takes time to arrange.

Reference: UK Renal Association Guidelines on Hyperkalaemia Management; NICE CKD Guidelines