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Life-threatening hyperkalaemia — SCE Acute Medicine MCQ

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HardRenal medicineLife-threatening hyperkalaemiaSCE Acute Medicine

A 73-year-old woman with chronic kidney disease is admitted with weakness after an ACE inhibitor dose increase. Potassium is 7.1 mmol/L and creatinine is 286 micromol/L. ECG shows broad QRS complexes and peaked T waves. She is awake and has a palpable pulse. What is the most important immediate action?

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Correct answer: C — Give intravenous calcium gluconate with continuous ECG monitoring

Life-threatening hyperkalaemia with ECG changes requires immediate myocardial membrane stabilisation with IV calcium. Insulin-glucose and salbutamol shift potassium intracellularly but should follow calcium when ECG toxicity is present. Potassium binders and dialysis may be needed, but they are not the first seconds-to-minutes intervention for broad QRS complexes.

Reference: UK Kidney Association Hyperkalaemia Guideline 2023; BNF