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Hyperkalaemia after missed dialysis — SCE Acute Medicine MCQ

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ModerateAcute Renal and Metabolic EmergenciesHyperkalaemia after missed dialysisSCE Acute Medicine

A 34-year-old woman 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 dialysis patient with potassium 7.4, peaked T waves and pulmonary oedema. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: C — Give intravenous calcium and arrange urgent dialysis with temporising therapy

The key discriminator is that dialysis patient with potassium 7.4, peaked T waves and pulmonary oedema, which makes Give intravenous calcium and arrange urgent dialysis with temporising therapy the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Give intravenous fluids with reassessment would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Start broad-spectrum intravenous antibiotics 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