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Nephrology

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A practice question

Choose an answer and it is marked, with the explanation. From Nephrology Practice Questions: 10 Cases With Explanations.

Question 11 mark

A 68-year-old with advanced chronic kidney disease has a potassium concentration of 7.1 mmol/L. The ECG shows tall, peaked T waves and a widening QRS complex. What is the most appropriate immediate treatment?

Intravenous calcium stabilises the cardiac membrane when hyperkalaemia is causing ECG changes. It does not lower serum potassium, so potassium-shifting and removal treatments are also required. Insulin with glucose can shift potassium intracellularly, but does not replace immediate membrane stabilisation in this presentation.

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