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Life-threatening hyperkalemia — ABEM Board MCQ

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HardRenal/Metabolic emergenciesLife-threatening hyperkalemiaABEM Board

A 66-year-old man with ESRD presents as triage level 1 with weakness after missing dialysis. ECG shows sine-wave morphology, potassium is 8.1 mEq/L, and BP is 92/58 mm Hg. Which of the following is the most appropriate initial action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — IV calcium chloride or calcium gluconate

ECG instability from hyperkalemia requires immediate IV calcium to stabilize the myocardium before shifting or removing potassium.

Reference: AHA ACLS electrolyte emergency guidance; ABEM EM Model