What is the initial therapy for hyperkalemia following crush injury?

What is the initial therapy for hyperkalemia following crush injury?

• A. Insulin with dextrose
• B. Sodium bicarbonate
• C. Calcium gluconate
• D. Kayexalate

Answer: (C)

Stabilizing the heart is the immediate priority when hyperkalemia occurs after crush injury. Calcium gluconate rapidly protects the myocardium by stabilizing the cell membranes, reducing the risk of life-threatening arrhythmias even before potassium levels are lowered. It does not lower potassium itself, but it buys time for definitive measures to reduce potassium or remove it from the body. After this membrane stabilization, you would address the potassium load with strategies that shift potassium into cells (such as insulin with glucose, and sometimes bicarbonate if acidosis is present) and remove it (diuretics, dialysis, or binders for slower clearance). The other options don’t provide that immediate cardiac stabilization: insulin with dextrose lowers potassium but doesn’t protect the heart right away; sodium bicarbonate helps with acidosis and modestly lowers K but isn’t the first-line rescue; Kayexalate acts slowly and isn’t for urgent stabilization.

Stabilizing the heart is the immediate priority when hyperkalemia occurs after crush injury. Calcium gluconate rapidly protects the myocardium by stabilizing the cell membranes, reducing the risk of life-threatening arrhythmias even before potassium levels are lowered. It does not lower potassium itself, but it buys time for definitive measures to reduce potassium or remove it from the body. After this membrane stabilization, you would address the potassium load with strategies that shift potassium into cells (such as insulin with glucose, and sometimes bicarbonate if acidosis is present) and remove it (diuretics, dialysis, or binders for slower clearance). The other options don’t provide that immediate cardiac stabilization: insulin with dextrose lowers potassium but doesn’t protect the heart right away; sodium bicarbonate helps with acidosis and modestly lowers K but isn’t the first-line rescue; Kayexalate acts slowly and isn’t for urgent stabilization.