What is the standard emergent management for hyperkalemia in kidney failure?

• A. Stabilize cardiac membranes with calcium gluconate; shift potassium into cells with insulin and glucose or albuterol; remove potassium with diuretics or dialysis; treat underlying cause
• B. Give potassium supplements
• C. Increase dietary potassium intake
• D. Use bicarbonate alone without shifting K

Answer: (A)

In acute hyperkalemia from kidney failure, the immediate goal is to protect the heart, shift potassium into cells, and then remove it from the body. Start by stabilizing the cardiac membranes with calcium (calcium gluconate or calcium chloride). This doesn’t lower potassium, but it reduces the risk of arrhythmias by decreasing myocardial excitability. Next, drive potassium into cells to lower the circulating level—use insulin with glucose to push potassium into cells, and a beta-2 agonist like albuterol can help as well. After stabilization and intracellular shifting, remove potassium from the body; diuretics may help if there is any remaining kidney function, but in kidney failure dialysis is often required to physically eliminate potassium. Finally, treat the underlying cause to prevent recurrence.

The other options don’t fit emergent management: giving potassium supplements or increasing dietary potassium would worsen the hyperkalemia, and bicarbonate alone is not reliably effective without the preceding steps of stabilization and intracellular shifting.