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Severe hyperkalaemia with ECG changes — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesSevere hyperkalaemia with ECG changesSCE Acute Medicine

A 73-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show potassium 7.1 with bradycardia and broad QRS complexes. What is the most important immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give intravenous calcium gluconate for myocardial membrane stabilisation

The key discriminator is that potassium 7.1 with bradycardia and broad QRS complexes, which makes Give intravenous calcium gluconate for myocardial membrane stabilisation the single best answer. Give broad-spectrum intravenous antibiotics within one hour is less appropriate because it does not address the dominant acute risk in the vignette; Give high-flow oxygen would fit a different presentation or later stage of care. Start acetylcysteine without delay and Call for urgent surgical source control are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: UKKA hyperkalaemia guideline; BNF