Which emergency measure should be given first to protect the heart in a patient with hyperkalemia (K+ 6.2 mEq/L)?

Which emergency measure should be given first to protect the heart in a patient with hyperkalemia (K+ 6.2 mEq/L)?

• A. IV calcium gluconate to stabilize cardiac membranes.
• B. Insulin with glucose to drive potassium into cells.
• C. Dialysis to remove potassium immediately.
• D. Potassium-sparing diuretic to reduce potassium

Answer: (A)

High potassium levels raise the risk of dangerous heart rhythms, so the first goal is to protect the heart. IV calcium gluconate does that by stabilizing the cardiac cell membranes, raising the threshold for depolarization and reducing excitability. This immediate membrane stabilization helps prevent life-threatening arrhythmias even though it doesn’t lower the potassium itself. After the heart is shielded, other treatments can move potassium into cells or remove it from the body (for example, insulin with glucose acts quickly to shift potassium intracellularly). Dialysis and potassium-wasting strategies may be used as well, but they don’t provide the immediate protection to the heart that calcium does.

High potassium levels raise the risk of dangerous heart rhythms, so the first goal is to protect the heart. IV calcium gluconate does that by stabilizing the cardiac cell membranes, raising the threshold for depolarization and reducing excitability. This immediate membrane stabilization helps prevent life-threatening arrhythmias even though it doesn’t lower the potassium itself. After the heart is shielded, other treatments can move potassium into cells or remove it from the body (for example, insulin with glucose acts quickly to shift potassium intracellularly). Dialysis and potassium-wasting strategies may be used as well, but they don’t provide the immediate protection to the heart that calcium does.