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Anaphylaxis — DIPIMC MCQ

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HardResuscitationAnaphylaxisDIPIMCDipIMC

A 63-year-old taking ramipril has weakness, K+ 6.9 mmol/L, broad QRS complexes and tall peaked T waves. Which drug should be given first while definitive potassium-lowering therapy is arranged?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give intravenous calcium to stabilise the cardiac membrane

The best answer is “Give intravenous calcium to stabilise the cardiac membrane”. Severe hyperkalaemia with ECG changes is immediately arrhythmogenic. IV calcium stabilises the cardiac membrane first; it does not lower serum potassium. Insulin-glucose and beta2 agonists shift potassium intracellularly, while binders remove potassium more slowly. Stopping ramipril is sensible later but cannot address current electrical instability.

Reference: UK Kidney Association, Hyperkalaemia guideline: https://guidelines.ukkidney.org/hyperkalaemia/