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Hyperkalaemia with ECG changes — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesHyperkalaemia with ECG changesSCE Acute Medicine

A 67-year-old man is assessed on the acute medical unit. He has CKD and weakness. Potassium is 7.1 mmol/L and ECG shows broad QRS complexes with peaked T waves. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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Correct answer: D — Give intravenous calcium gluconate immediately

Give intravenous calcium gluconate immediately is the best answer because ECG changes in severe hyperkalaemia require immediate myocardial membrane stabilisation with IV calcium. Stop the suspected causative drug and resuscitate is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Insulin-glucose shifts potassium but does not stabilise the myocardium.

Reference: UK Kidney Association hyperkalaemia guideline