A 68-year-old man with CKD stage 4 (eGFR 22 mL/min/1.73m²) and type 2 diabetes is on lisinopril, furosemide, and amlodipine. He develops serum potassium of 6.2 mEq/L on routine bloods with no ECG changes. Which intervention is MOST appropriate FIRST?
- A Dietary potassium restriction and reduce/stop lisinopril ✓
- B Sodium polystyrene sulphonate (kayexalate) as emergency treatment
- C IV calcium gluconate to stabilise the cardiac membrane
- D Emergency haemodialysis
Correct answer: A. Dietary potassium restriction and reduce/stop lisinopril
Explanation
In a haemodynamically stable patient with K+ 6.2 mEq/L and no ECG changes, initial management is dietary potassium restriction (<2 g/day) and review/reduction of potassium-raising medications (ACE inhibitors, potassium-sparing diuretics). Lisinopril should be dose-reduced or held. IV calcium gluconate is indicated only for ECG changes (peaked T waves, wide QRS, sine wave). Emergency haemodialysis is reserved for severe, refractory, or symptomatic hyperkalaemia. Kayexalate has slow onset and significant GI side effects.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.