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Severe hyperkalaemia with ECG changes — SCE Acute Medicine MCQ

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ModerateRenal medicineSevere hyperkalaemia with ECG changesSCE Acute Medicine

A 69-year-old man with CKD stage 4 presents with weakness after starting spironolactone. ECG shows broad QRS complexes and peaked T waves. Potassium is 7.1 mmol/L and venous pH is 7.29. What is the most appropriate immediate action?

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Correct answer: D — Give intravenous calcium gluconate to stabilise the myocardium

Severe hyperkalaemia with ECG changes requires immediate intravenous calcium to stabilise the myocardium before potassium-shifting therapies. Insulin-glucose and beta-agonists reduce serum potassium but do not protect the heart as quickly as calcium. Potassium binders can help remove potassium but are not the first action in ECG-toxic hyperkalaemia.

Reference: UK Kidney Association hyperkalaemia guideline 2023; BNF hyperkalaemia