ESRD on hemodialysis. Missed his last 2 sessions.
Now weak legs, numb hands, "my heart feels funny."
Stat labs: potassium 7.1 mEq/L. ECG: tall peaked T waves.
◀ All casesCase 5 of 8
Case 5 · Hyperkalemia
Missed Dialysis
Bedside monitorLive
K+7.1
HR48
BP98/60
SpO296%
What do you do?
Answer: B) Cardiac monitor + call provider STAT for IV calcium
Continuous cardiac monitor and call the provider STAT. Expect IV calcium gluconate first.
Calcium protects the heart but doesn't lower K+. Then shift it: IV insulin + dextrose (watch glucose). Then remove it: binders and urgent dialysis.
WHY: Peaked T waves + bradycardia = the heart is already affected. Don't delay treatment to redraw. This rhythm can turn deadly fast.
RememberHigh K+ with ECG changes? Protect the heart first.