A patient with chronic renal failure presents to the emergency department with symptoms of marked fatigue, confusion, and shortness of breath. The patient's current medications include calcium acetate, erythropoietin, and furosemide. Laboratory reports reveal hyperkalemia. What is the most appropriate initial management for this patient?
Start insulin and dextrose infusion
Administer calcium gluconate
Oral administration of sodium polystyrene sulfonate
The appropriate initial management for this patient, who shows signs of hyperkalemia, is administration of calcium gluconate. Calcium gluconate works by stabilizing the cardiac membrane against the effects of elevated serum potassium levels, which is essential to prevent further cardiac complications until more definitive hyperkalemia treatments can take effect. Insulin and dextrose, while used to treat hyperkalemia by driving potassium back into cells, are not the immediate treatment for cardiac protection. Sodium polystyrene sulfonate aids in the removal of excess potassium but acts slower and is not indicated for urgent symptom management.
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