Hyperkalaemia Dental Risk — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementHyperkalaemia Dental RiskORE Part 1

A patient with chronic renal failure attends for an elective extraction. Their same-day serum potassium concentration is 6.2 mmol/L (reference range 3.5–5.0 mmol/L). What is the most appropriate management?

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Correct answer: E — Defer treatment and arrange urgent medical assessment

Explanation lettering: E = shown as A · D = shown as B · B = shown as D · A = shown as E

A is correct. A potassium concentration of 6.2 mmol/L is moderate hyperkalaemia and, in chronic renal failure, requires urgent medical assessment rather than elective dental care. Hyperkalaemia can impair cardiac conduction and may produce potentially fatal arrhythmias or cardiac arrest, including without warning. Elective extraction should therefore be deferred while the result is confirmed and medically managed. Being asymptomatic does not make proceeding safe (B). Altering local-anaesthetic dose neither treats the electrolyte disturbance nor removes the cardiac risk (C). Advice on fluids is not an adequate response to significant hyperkalaemia in renal failure (D), and antibiotic prophylaxis has no role in correcting potassium-related cardiac risk (E).

Reference: NHS Improvement, Patient Safety Alert: Resources to support safe and timely management of hyperkalaemia, 2018. https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=103084