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Repeated Calcium Gluconate Hyperkalaemia — ESENeph MCQ

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ModerateElectrolyte DisordersRepeated Calcium Gluconate HyperkalaemiaESENeph

A 35-year-old man develops severe hyperkalaemia (K+ 7.5 mmol/L) with sine wave pattern on ECG. He has end-stage renal failure and missed dialysis. IV calcium gluconate 30 mL (three ampoules) has been given. The ECG normalises temporarily but the sine wave recurs after 30 minutes. What should be done?

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Correct answer: C — Repeat IV calcium gluconate – it can be repeated if ECG changes recur

IV calcium gluconate can be repeated if ECG changes recur after the initial dose. There is no absolute maximum dose in the emergency setting – the dose is titrated to ECG response. Each dose provides approximately 30-60 minutes of cardiac membrane stabilisation. Meanwhile, potassium-lowering treatments (insulin/dextrose, salbutamol) should be given simultaneously, and emergency haemodialysis arranged for definitive management. Calcium chloride provides more elemental calcium per volume but is more tissue-toxic if extravasated.

Reference: UK Renal Association 2020 – Hyperkalaemia; Resuscitation Council UK 2021