Hyperkalemia with no ECG finding. The drug that should not be used isaEUR’
Correct Answer: Calcium gluconate
Description: Calcium gluconate (Also see AIIMS May 2010) . Calcium gluconate is the fastest acting agent used in t/t of hyperkalemia. . In acts within nzinutes but an impoant point to note is that it does not cause transcellular movement of potassium, instead it acts on cell membrane. - It stabilizes the cardiac cell membrane and reduces chances of cardiac arryhthmia. - Thus it has no use when there are no E.C.G. features. NaHCO3 NaHCO3 has been routinely used in the treatment of hyperkalemia. It was believed that NaHCO3 caused movement of potassium inside the cells by causing alkalosis. But studies do not suppo this - They claim that NaHCO3 do not cause movement of potassium inside the cells in acute cases of hyperkalemia. - It only decreases potassium when there is coexisting acidosis. - NaHCO3 can decrease potassium level in chronic hyperkalemia. It increases potassium delivery to the kidney. But the use of NaHCO3 still continues in most hospitals and institutes across the world. - It is now hypothesized that NaHCO3 does not cause IC* entry inside the cell by mechanism earlier believed to be, but by another mechanism. The question does not say anything about acidosis. Don't think that acidosis occurs only in severe hyperkalemia. Most patients with C.R. F. present with acidosis and mild moderate hyperkalemia. In hyperkalemia with no E.C.G. feature, calcium prophylaxis is not indicated - Calcium gluconate is administered to stabilize the cardiac membrane - Instability of the cardiac membrane is indicated by E.C.G. changes - Absence of E.C.G. changes suggest that the cardiac membrane is stable. In these cases there is no use of calcium administration. Prophylactic calcium gluconate is of no use.
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