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Life-threatening hyperkalemia — ABIM Board MCQ

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HardNephrologyLife-threatening hyperkalemiaABIM Board

A 63-year-old with diabetic CKD has weakness, potassium 7.0 mEq/L and an ECG showing peaked T waves with QRS widening. Which treatment sequence is required immediately?

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Correct answer: B — Give intravenous calcium, potassium shifting and potassium removal

The best answer is “Give intravenous calcium, potassium shifting and potassium removal”. Toxic ECG changes require immediate myocardial membrane stabilization with intravenous calcium. Insulin with dextrose and other indicated measures then shift potassium, while binders, diuresis or dialysis provide removal; ECG and potassium must be rechecked. Removal alone is too slow to protect the myocardium, and bicarbonate alone is unreliable.

Reference: KDIGO Conference Report on Acute Hyperkalemia in the Emergency Department: https://pubmed.ncbi.nlm.nih.gov/31064689/