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Answer 4
  1. Calcium gluconate, intravenously. Rapid treatment of severe hyperkalemia is required to prevent the occurrence of life-threatening cardiac arrythmias. The most appropriate initial therapy entails the stabilization of excitable cardiac membranes with calcium gluconate, administered intravenously. This intervention often reverses the abnormal changes on electrocardiogram. However, this effect is short-lived (approximately 30 minutes), and administration may need to be repeated. A reduction in serum potassium is the next step in treatment. Intravenous administration of insulin plus glucose and administration of a nebulized ß2-agonist are the most effective therapies to lower serum potassium by shifting this cation into cells. Removal of excess potassium from the body can be achieved through the gastrointestinal tract with sodium polystyrene sulfonate resin or through the blood by hemodialysis.

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