* The ECG shows a hea rate of 125 bpm with extreme axis detion. * P waves are absent with bizarre wide complex qRS in lead V4, V5, and V6 * Tall tented T waves which are seen with hyperkalemia, are present in all the leads. * The patient is a diabetic with deranged KFT. The patient is suffering from CKD and must be reaching stage 4-5 leading to hyperkalemia producing such pronounced ECG changes. * He is at risk of diastolic arrest of the hea. Hence the control of potassium is of paramount impoance in this patient. -Hyperkalemia in CKD patients responds to 1. Dietary restriction of potassium with use of kaliuretic diuretics 2. Potassium-binding resins like calcium resonium and sodium polystyrene can promote potassium loss GI Tract 3. Intractable hyperkalemia requires dialysis. A component should be managed with alkali supplementation if bicarbonate falls below 20 mmol/L.