A 6-year-old with chronic kidney disease presents with vomiting, weakness, and serum potassium of 7.8 mEq/L. ECG shows peaked T waves and loss of P waves. Which of the following should be administered first to stabilize the myocardium?
- A IV calcium gluconate 10% 0.5 mL/kg over 3-5 minutes ✓
- B IV sodium bicarbonate 1 mEq/kg
- C IV insulin 0.1 U/kg with dextrose 0.5 g/kg
- D Inhaled salbutamol 2.5 mg nebulization
Correct answer: A. IV calcium gluconate 10% 0.5 mL/kg over 3-5 minutes
Explanation
Calcium gluconate (or calcium chloride) is the first-line cardioprotective agent in hyperkalemia with ECG changes. It stabilizes the cardiac membrane within 1-3 minutes but does not lower potassium. Insulin with glucose, bicarbonate, and salbutamol shift potassium intracellularly but take 15-30 minutes. Calcium must precede these temporizing measures when ECG changes are present.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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