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Severe hyperkalaemia — ESENeph MCQ

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EasyAcute Kidney Injury, Electrolytes and Acid-BaseSevere hyperkalaemiaESENeph

A 64-year-old man with CKD G4 presents with weakness and palpitations after missing clinic follow-up. Potassium is 7.1 mmol/L and ECG shows broad QRS complexes with peaked T waves. Glucose is 8.2 mmol/L and bicarbonate is 18 mmol/L. What is the most appropriate immediate management?

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Correct answer: C — Intravenous calcium gluconate followed by insulin-glucose therapy

ECG changes in severe hyperkalaemia require immediate myocardial membrane stabilisation with intravenous calcium, followed by measures that shift potassium intracellularly such as insulin-glucose. Potassium binders may help remove potassium but are not sufficient as sole immediate treatment with ECG instability. Dialysis may be needed, but calcium should not be delayed while arranging it. The pearl is that calcium does not lower potassium; it buys time to lower potassium safely.

Reference: UKKA Clinical Practice Guideline: Management of Hyperkalaemia in Adults; BNF