A patient with a history of chronic kidney disease presents with marked lethargy and weakness. Vital signs reveal bradycardia and hypotension. Lab results show a serum potassium level of 7.0 mEq/L. Which intervention should the emergency nurse prioritize?
Administer regular insulin with dextrose to drive potassium into cells
Provide nebulized albuterol to promote potassium uptake in cells
Give sodium polystyrene sulfonate (Kayexalate) to decrease potassium levels
Administer intravenous calcium to stabilize cardiac membranes
In patients with hyperkalemia, the priority is to stabilize cardiac membranes to prevent arrhythmias, particularly when the patient exhibits ECG changes or is symptomatic, as in the provided case. While insulin and dextrose, as well as nebulized albuterol, would also help to temporarily shift potassium into cells, the stabilization of cardiac cells with calcium is the most immediate need. Kayexalate is used to remove potassium from the body but acts more slowly and would not address the immediate risk of cardiac arrhythmias.
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