PAEA Surgery End Of Rotation (EOR) Practice Exam

What treatments can temporarily lower potassium levels above 6 mEq/L?

1. Calcium gluconate and sodium bicarbonate

2. Insulin and glucose, kayexalate

3. All of the above

4. Lipid emulsion therapy

The correct answer is: All of the above

When dealing with elevated potassium levels, particularly when they reach 6 mEq/L or higher, it is crucial to implement treatments that can help stabilize the cardiac function and temporarily lower the serum potassium. Both calcium gluconate and sodium bicarbonate play significant roles in this context. Calcium gluconate is utilized to stabilize cardiac myocytes against the effects of hyperkalemia, as elevated potassium can increase the risk of cardiac arrhythmias. Sodium bicarbonate can drive potassium back into cells, reducing serum potassium levels temporarily, especially in cases of acidosis. Similarly, insulin and glucose can significantly lower potassium levels. Insulin facilitates the uptake of potassium into cells, which is particularly effective for acute management of hyperkalemia. Glucose is administered alongside insulin to prevent hypoglycemia, as insulin drives glucose into cells, which can also facilitate the movement of potassium intracellularly. Kayexalate is an exchange resin that can be used to lower potassium levels by binding potassium in the gastrointestinal tract, promoting its excretion. While it is not an immediate treatment, it is effective for longer-term management of hyperkalemia. Lipid emulsion therapy, though useful in certain contexts like local anesthetic toxicity, does not have a role in the direct treatment of