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Life-threatening hyperkalaemia — FRCA Final MCQ

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EasyICULife-threatening hyperkalaemiaFRCA Final

A 45-year-old man with crush injury has potassium 7.1 mmol/L, pH 7.18, creatine kinase 62,000 IU/L and peaked T waves with QRS widening. He is conscious but hypotensive after pelvic fixation. What is the most important next step?

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Correct answer: C — Give intravenous calcium gluconate immediately

ECG changes with severe hyperkalaemia require immediate myocardial stabilisation with intravenous calcium. Insulin-glucose, salbutamol and renal replacement therapy may then reduce potassium, but they should not precede cardiac protection. Furosemide is unreliable in shock or evolving renal failure. The key point is that a widened QRS in hyperkalaemia is a pre-arrest finding.

Reference: UK Kidney Association hyperkalaemia guideline; Resuscitation Council UK ALS guidance