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A 54-year-old male with type 2 diabetes presents with a serum potassium of 6.4 mEq/L and peaked T waves on ECG. Which is the most appropriate immediate step?
Membrane stabilisation comes first in hyperkalaemia with ECG changes. Calcium gluconate acts within minutes; insulin–dextrose only shifts potassium intracellularly.
Rajasthan • Medical • Government
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Hyperkalaemia with ECG changes is a cardiac emergency. Calcium gluconate raises the threshold potential and stabilises the myocardium within 1–3 minutes, buying time for potassium-lowering measures.
A: binders act over hours. B: insulin–dextrose shifts potassium intracellularly in 15–30 minutes but does not protect the myocardium first. D: dialysis is definitive but cannot be arranged immediately.
Sequence in hyperkalaemia: stabilise the membrane, then shift potassium intracellularly, then remove it from the body.
Whenever the stem mentions ECG changes with high potassium, the first step in the answer is always calcium.
C·S·R — Calcium, Shift, Remove.
K+ > 6.0 with peaked T waves → IV calcium gluconate first, then insulin–dextrose, salbutamol, then dialysis.
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