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Hyperkalemia with ECG changes — ABEM Board MCQ

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EasyRenal/Metabolic emergenciesHyperkalemia with ECG changesABEM Board

A 68-year-old man with end-stage kidney disease arrives weak after missing dialysis. Triage acuity is ESI 1; BP 104/66 mm Hg, HR 38/min. ECG shows peaked T waves, PR prolongation, and QRS widening. Potassium is 7.4 mEq/L. Which of the following is the most likely diagnosis?

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Correct answer: A — Life-threatening hyperkalemia

Missed dialysis, severe hyperkalemia, bradycardia, peaked T waves, PR prolongation, and QRS widening indicate life-threatening hyperkalemia.

Reference: KDIGO hyperkalemia guidance; emergency nephrology references