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학습 자료 둘러보기 →In a patient with acute kidney injury and severe hyperkalemia (K+ 7.2 mEq/L) with cardiac arrhythmias, the priority is to antagonize the cardiotoxic effects. Administer IV calcium gluconate first to stabilize the myocardial cell membrane.
Calcium does not lower serum potassium but raises the threshold potential, restoring normal electrical conduction. ECG changes in hyperkalemia progress from peaked T-waves to a widened QRS and a sine-wave pattern, which can rapidly deteriorate into ventricular fibrillation.
Do not delay cardioprotection for potassium-removal therapies like hemodialysis or Kayexalate. These are secondary interventions that work too slowly to prevent an imminent cardiac arrest.
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