karusmle
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A 67-year-old man is hospitalized for treatment of renal insufficiency. Three days after admission, his pulse is 40/min. An ECG shows tall, tented T waves. Serum studies show a sodium level of 134 mEq/L, potassium level of 6.9 mEq/L, and glucose level of 85 mg/dL. The most appropriate next step in management is intravenous administration of which of the following?
A) Calcium, furosemide, and 3% saline
B) Calcium, insulin, and digitalis
C) Calcium, insulin, and glucose
D) Glucose, furosemide, and phosphate
E) Glucose, glucagon, and bicarbonate
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| MAZI
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correcct answer C
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| AAAAA
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Well, it should be calcium gluconate, glucose , then insulin !! (C is acceptable !)
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| AAAAA
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Prehospital Care: A patient with known hyperkalemia or renal failure with suspected hyperkalemia should have intravenous (IV) access established and should be placed on a cardiac monitor. In the presence of hypotension or marked QRS widening, IV bicarbonate, calcium, and insulin given together with 50% dextrose may be appropriate as discussed in Medication. Avoid calcium if digoxin toxicity is suspected.
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| AAAAA
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Calcium chloride or calcium gluconate is used to protect the HEART !!!
Calcium chloride or calcium gluconate (Kalcinate) -- Calcium increases threshold potential, thus restoring normal gradient between threshold potential and resting membrane potential, which is elevated abnormally in hyperkalemia. One ampule of calcium chloride has approximately 3 times more calcium than calcium gluconate. Onset of action is <5 min and lasts about 30-60 min. Doses should be titrated with constant monitoring of ECG changes during administration; repeat dose if ECG changes do not normalize within 3 - 5 min
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| AAAAA
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Hyperkalemia EKG findings :
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k_3a.jpg (39 KB, 11 downloads)
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| AAAAA
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EKG changes
Early changes of hyperkalemia include peaked T waves, shortened QT interval, and ST segment depression (
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| infliximab
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C
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