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Hyperkalaemia with ECG instability — RCPSC EM MCQ

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ModerateCardiovascular emergenciesHyperkalaemia with ECG instabilityRCPSC EM

CTAS 1: A dialysis patient presents with weakness after missing two sessions. Vitals are BP 108/62, HR 42, RR 18. ECG shows sine-wave widening. Venous potassium returns at 8.1 mmol/L and creatinine is markedly elevated. What is the most appropriate initial management?

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Correct answer: E — Intravenous calcium followed by potassium-shifting therapy and dialysis activation

ECG changes in severe hyperkalaemia require immediate IV calcium to stabilise myocardium, then insulin/glucose, beta-agonist and definitive potassium removal such as dialysis.

Reference: ACLS electrolyte emergencies; Canadian nephrology emergency practice