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학습 자료 둘러보기 →In AKI, a serum potassium level of 7.2 mEq/L with peaked T waves on ECG is a pre-arrest emergency. This indicates severe cardiotoxicity from impaired renal excretion, requiring immediate intervention before dialysis or other AKI management steps.
The immediate priority is to stabilize the cardiac membrane. Administer IV calcium gluconate or calcium chloride first to antagonize the myocardial effects of potassium. This does not lower serum potassium but protects the heart.
Subsequent steps involve shifting potassium intracellularly with IV regular insulin and dextrose, and often a beta-2 agonist like albuterol. Definitive removal is achieved via renal replacement therapy or potassium binders.
Never prioritize rising creatinine or oliguria over ECG changes from hyperkalemia. A potassium >6.5 mEq/L with ECG changes is a code-blue risk; treatment must begin within minutes.
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