A 39yo man with acute renal failure presents with palpitations

A 39yo man with acute renal failure presents with palpitations. His ECG shows tall tented T waves and wide QRS complex. What is the next best step?

a. Dialysis
b. IV calcium chloride
c. IV insulin w/ dextrose
d. Calcium resonium
e. Nebulized salbutamo

Clincher(s) Tall tented t waves and wide qrs and acute renal failure A Persistent hyper kalemia >7mmol/l needs dialysis B C Once cardio protective agent is given then we give this. D Calcium resonium is a polystyrene cation exchange resin which acts to remove excess potassium from the body by exchanging it for the cation ion (Ca++) in the resin. It is a relatively slow method of reducing serum potassium.

E Can be given if insulin and dextrose can’t be given as it helps moves the potassium inside the cell but can increase the pulse. KEY B Additional Information
Reference Dr Khalid/Rabia IV calcium chloride (both IV calcium gluconate or IV calcium chloride can be used) when there is ECG changes. DX The ECG changes are suggestive of Hyperkalemia. At potassium level of >5.5mEq/L occurs tall tented T waves and at potassium level >7mEq/L occurs wide QRS complex with bizarre QRS morphology.