Renal
Severe hyperkalemia
Protect a toxic myocardium first, and do not confuse that step with lowering the potassium.
Educational only. A local note appears only when a public source is attached. This page does not say that one exam, or training in one country, makes you eligible to practice in another.
Global core
A high potassium with ECG change, weakness, or a very high number is an emergency. Calcium stabilizes the myocardium. It does not lower the potassium. Insulin with glucose, and a beta agonist, shift potassium into cells temporarily. Removal needs a resin, a binder, dialysis, or treatment of the cause. Stop the offending drug.
What stays the same
- Peaked T waves and a widening QRS are an emergency.
- Intravenous calcium stabilizes the membrane. It does not lower the serum number.
- Shift and removal still have to follow, and the offending drug stops.
- Recognize. Weakness, a peaked T wave, a wide QRS, or a lab call in a patient on an ACE inhibitor or a potassium-sparing drug.
- Reason. The ECG decides urgency. The drug list decides the cause.
- Prioritize. A sine wave or loss of P waves is impending arrest.
- Act safely. Protect the heart if the ECG is toxic, shift potassium, remove it, and stop the cause.
Local adaptation
No sourced local note is attached to this topic. That is not a statement that every country manages it the same way. The shared principle above is what this beta is willing to teach.
Exam lens
Calcium versus insulin versus removal, in the right order.
Original case · shared decision
The lens above is how that exam usually frames the medicine. This case stays on the shared decision. Not an official examination item.
A 68-year-old man on lisinopril and spironolactone has a potassium of 6.8 mmol/L. The ECG shows peaked T waves and a widened QRS. Blood pressure is 110/70 mm Hg. What is the most appropriate immediate drug for the heart?