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Severe hyperkalaemia with ECG changes — RCPSC EM MCQ

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HardCardiovascular emergenciesSevere hyperkalaemia with ECG changesRCPSC EM

A man with end-stage kidney disease missed dialysis and presents with potassium 7.4 mmol/L, QRS widening and bicarbonate 16 mmol/L. IV calcium and insulin with dextrose have been given with transient ECG improvement. What is the next definitive plan?

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Correct answer: B — Arrange urgent haemodialysis and continue cardiac monitoring

The best answer is “Arrange urgent haemodialysis and continue cardiac monitoring”. Calcium and insulin are temporising measures: they protect myocardium or shift potassium but do not remove the substantial potassium burden. In a dialysis-dependent patient with severe hyperkalemia and acidosis, urgent dialysis is definitive treatment, with continued monitoring because rebound and dysrhythmia remain possible.

Reference: Emergency Care BC: Hyperkalemia—Diagnosis and Treatment: https://emergencycarebc.ca/clinical_resource/clinical-summary/hyperkalemia-diagnosis-and-treatment/