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Life-threatening hyperkalaemia with ECG changes — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesLife-threatening hyperkalaemia with ECG changesSCE Acute Medicine

A 70-year-old man with CKD presents with weakness after starting spironolactone. Potassium is 7.1 mmol/L and ECG shows broad QRS complexes with peaked T waves. What is the most appropriate immediate treatment?

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Correct answer: A — Give intravenous calcium gluconate to stabilise the myocardium

ECG changes with severe hyperkalaemia require immediate IV calcium to stabilise cardiac membranes. Salbutamol and insulin-dextrose shift potassium intracellularly but do not stabilise myocardium as the first immediate priority. Potassium binders are slower adjuncts. If the ECG is dangerous, treatment should not wait for repeat sampling.

Reference: UK Kidney Association hyperkalaemia guideline, BNF