A client with ESRD has K+ 7.2 with peaked T waves on ECG. Wh… | MyMerci
Medical Emergencies PA
Question

A client with ESRD has K+ 7.2 with peaked T waves on ECG. Which is the priority medication?

Explanation
Correct (2): Severe hyperkalemia with ECG changes — first IV calcium gluconate to stabilize cardiac membrane (rapid, no K removal). Then K shift: insulin + dextrose, beta-2 (albuterol), sodium bicarbonate if acidotic. Then K removal: sodium polystyrene sulfonate/patiromer/sodium zirconium or dialysis. (1) Hypoglycemia. (3,4) Worsen.

In-depth explanation

Memory Tip Hyperkalemia ladder = "C BIG K Drop" — Calcium, Beta-2, Insulin/dex, Glucose, Kayexalate, Dialysis. Calcium does NOT lower K but protects heart.

Clinical scenario

Scenario 65-year-old male ESRD missed HD. K+ 7.2 mEq/L·peaked T waves·widening QRS.

Key concepts

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