A patient presents with peaked T waves on ECG and a potassium of 7.0 mEq/L. What is the immediate treatment?

• A. IV calcium gluconate to stabilize the myocardium
• B. Insulin with glucose
• C. Sodium bicarbonate therapy
• D. Hyperventilation

Answer: (A)

When potassium is this high and the ECG already shows changes, the priority is to protect the heart by stabilizing the cardiac membranes. IV calcium gluconate quickly stabilizes the myocardium by increasing the threshold potential, reducing excitability and the risk of arrhythmias, even though it does not lower the potassium level itself. This stabilization buys time to address the excess potassium.

After the heart is stabilized, you would next shift potassium into cells (for example with insulin plus glucose) and/or give beta-agonists or bicarbonate if appropriate, to lower the serum potassium, and then remove potassium from the body (diuretics, dialysis) depending on the patient’s renal function and overall status. Hyperventilation is not the primary or reliable treatment for hyperkalemia in this scenario.

So, the immediate treatment is to give IV calcium gluconate to stabilize the myocardium.