Question of the Week # 314

314)  A 70-year-old man presented to the Emergency room with a 2-day history of increased thirst and frequency of urination. He reports generalized muscle weakness. His past medical history is significant for hypertension, diabetes mellitus and Stage III chronic kidney disease. His medications include Insulin Glargine, Lispro insulin, Enalapril , Atenolol and Spironolactone.  Laboratory investigations reveal

Blood glucose 400mg%

Sodium 130 mEq/L

Potassium 7.5 mEq/L

Bicarbonate 26mEq/L

Chloride 100mEq/L

Creatinine 4.2mg%

An electrocardiogram is shown below:


Which of the following is the most appropriate next step?

A) Reduce the dose of Enalapril

B) Hemodialysis

C) Insulin Intravenous

D) Calcium Gluconate IV

E) Sodium biacrbonate IV

11 Responses

  1. Calcium gluconate

  2. D) Calcium Gluconate IV

  3. obviously hyperkalemia


  4. d

  5. D – It is cardioprotective.

  6. d IV calcium gluconate

  7. ddd

  8. D

    calcium gluconate yhen iv insulin and nss

  9. Ekg exhibits tented T waves across all leads, which is hyperkalemia. Ekg evidence of hyperkalemia requires cardiac membrane stabilisation with iv calcium gluconate other) otherwise there is significant risk of progression to ventricular tachyarythmia /vfib. This should be given together with iv insulin and fluids to treat the hyperkalemia itself pushing the excess potassium from the ecf into the icf compartment. Resistant severe cases of hyperkalemia require removal to total body potassium with resins

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