What is the first step in treating hyperkalemia?

• A. Administration of insulin and glucose
• B. Infusion of calcium gluconate
• C. Use of Kayexalate
• D. Dialysis

Answer: (B)

The initial step in the treatment of hyperkalemia is the infusion of calcium gluconate. Hyperkalemia can lead to life-threatening complications, particularly cardiac issues, due to its effect on myocardial excitability. Calcium gluconate acts quickly to stabilize the cardiac membrane, thereby reducing the risk of arrhythmias associated with elevated potassium levels. By counteracting the effects of hyperkalemia on the heart, calcium gluconate provides critical protection while other treatments are instituted.

Following the stabilization of the cardiac membrane, additional treatments can be initiated to lower the serum potassium level, such as administering insulin and glucose to facilitate the cellular uptake of potassium or using Kayexalate to promote gastrointestinal potassium exchange. Dialysis is typically reserved for severe cases or when other treatments fail, making calcium gluconate the preferred first step in a clinical emergency.