The first-line management of hyperkalemia with ECG changes includes which medication?

• A. Calcium gluconate to stabilize myocardium, followed by insulin with glucose and other redistributive measures.
• B. Sodium bicarbonate alone
• C. Dialysis
• D. Potassium-sparing diuretics

Answer: (A)

Calcium gluconate is given right away to protect the heart when hyperkalemia has ECG changes. It stabilizes the cardiac cell membranes, raising the threshold for depolarization so the myocardium becomes less irritable and less prone to dangerous arrhythmias. It does not lower potassium itself, but buys time for treatments that actually reduce potassium levels. After membrane stabilization, therapies that shift potassium into cells are used, with insulin given alongside glucose to drive potassium intracellularly. Additional redistributive measures like beta-agonists or bicarbonate (if there’s acidosis) may be used as needed. Only after these immediate steps are underway would definitive potassium removal strategies such as dialysis be considered, with diuretics or other means used based on the clinical context. In contrast, options that only remove potassium, or that don’t stabilize the heart promptly, aren’t first-line in the setting of ECG changes, and potassium-sparing diuretics would worsen the situation.