PAEA Surgery End Of Rotation (EOR) Practice Exam

How should a patient with hyperkalemia be treated?

1. Administer sodium chloride

2. Treat with glucose/insulin, and calcium +/- bicarb

3. Increase dietary potassium

4. Use loop diuretics

The correct answer is: Treat with glucose/insulin, and calcium +/- bicarb

The appropriate treatment for a patient with hyperkalemia involves administering glucose and insulin, and potentially calcium and bicarbonate, depending on the severity of the hyperkalemia and the patient's clinical status. Glucose and insulin drive potassium back into the cells, effectively lowering serum potassium levels. This is particularly important in cases of acute hyperkalemia, where time is of the essence to prevent complications such as cardiac arrhythmias. Calcium is included in the treatment regimen to stabilize the cardiac membranes, reducing the risk of arrhythmias that can arise from elevated potassium levels. Bicarbonate can also be used in cases associated with acidosis, as it can help shift potassium into cells. In contrast, administering sodium chloride does not directly address the underlying issue of elevated potassium levels. Increasing dietary potassium may further exacerbate the hyperkalemia and should be avoided in this situation. While loop diuretics can help eliminate potassium by increasing renal excretion, they may not act quickly enough in acute cases and are generally considered a secondary line of treatment. Thus, the initial and most effective management focuses on insulin and glucose, with calcium and bicarbonate as adjuncts.