Hypokalaemia and hyperkalaemia — viva

Opening (must-hit)

"This is severe hyperkalaemia with cardiotoxic ECG changes — a widened QRS and peaked T waves — and it is a cardiac emergency. My first action is to give intravenous 10 percent calcium gluconate at 0.5 mL per kilogram, maximum about 10 mL, slowly over 5 minutes with continuous cardiac monitoring, to stabilise the myocardium. This does not lower the potassium, so I immediately follow with a shifting agent — nebulised salbutamol and insulin-dextrose — and I arrange definitive removal of potassium, likely dialysis given the acute kidney injury. I do not wait for a repeat potassium; the ECG tells me to act now." ^[2][3]