A 40yo male with pre-existing glumerulonephritis having proteinuria and hematuria suddenly
deteriorates and presents with oliguria and serum K+=7.8mmol/L, urea=13mmol/L,
creat=342mmol/L, GFR=19mL/h. The best management would be?
a. Calcium supplement
b. Calcium resonate enema 30g
c. 10units insulin with 50% dextrose
d. Nebulized salbutamol
e. 10ml of 10% calcium gluconate
f. Hemodialysis urgent
Q. 1. What is the key?
Q. 2. Justify the key.
Ans. 1. The key is E. 10 ml of 10% calcium gluconate.
Ans. 2. To prevent cardiac arrhythmia. [Actually calcium gluconate neither shifts K+ to cells nor reduces serum K+ level that much. It just prevents cardiac arrest or life threatening cardiac arrhythmia and buys time till definitive measures are taken].