Question 2 of 28

A 49-year-old dialysis patient presents with generalized weakness. His EKG shows peaked T waves and a widened QRS complex. The most appropriate initial therapy should include:

Intravenous glucose and insulin.

Intravenous sodium bicarbonate.

Intravenous calcium gluconate.

Nebulized albuterol.

Oral or rectal sodium polystyrene sulfonate (Kayexalate).

While nebulized albuterol will reliably lower the serum potassium rapidly, calcium salts act immediately by stabilizing cell membranes and is the recommended first line agent in the setting of a wide QRS complex. The duration of action of the calcium is approximately 20–40 minutes. Bicarbonate should not be used unless the patient is acidemic. The other therapies will reduce the serum potassium level but have longer onsets of action.