A 70-year-old man with CKD and heart failure presents with weakness. Potassium is 7.1 mmol/L, creatinine is 268 micromol/L and ECG shows peaked T

Question

A 70-year-old man with CKD and heart failure presents with weakness. Potassium is 7.1 mmol/L, creatinine is 268 micromol/L and ECG shows peaked T waves with QRS widening. He takes ramipril and spironolactone. What is the most appropriate management?

Accepted Answer

Intravenous calcium gluconate immediately, followed by potassium-shifting and potassium-removal therapy

Answer

Oral sodium polystyrene sulfonate as sole urgent therapy

Answer

Intravenous furosemide before cardiac membrane stabilisation

Answer

Repeat potassium in 6 hours before treating

Answer

Stop ramipril and discharge

Life-threatening hyperkalemia — RCPSC IM MCQ

A 70-year-old man with CKD and heart failure presents with weakness. Potassium is 7.1 mmol/L, creatinine is 268 micromol/L and ECG shows peaked T waves with QRS widening. He takes ramipril and spironolactone. What is the most appropriate management?