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Chronic hyperkalemia — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Chronic hyperkalemiaUSMLE Step 3

A patient with stable HFrEF and CKD has potassium 5.7 mEq/L on routine testing, normal ECG and no weakness. They take lisinopril and spironolactone. What is the best next step?

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Correct answer: A — Review contributors, start potassium-lowering therapy and repeat potassium shortly

The best answer is “Review contributors, start potassium-lowering therapy and repeat potassium shortly”. Stable potassium 5.7 mEq/L without electrocardiographic changes needs prompt reassessment rather than emergent calcium. Review medicines and diet, preserve evidence-based RAAS therapy where possible, and use potassium-lowering treatment with early repeat measurement. Potassium chloride worsens hyperkalemia; thrombolysis and annual follow-up have no role.

Reference: American Heart Association, Adult Advanced Cardiovascular Life Support: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines