A 74-year-old patient found down with pH 7.20, potassium 6.8, lactate 8.7. Which intervention is priority?

• A. Administration of calcium gluconate
• B. Initiate nebulized albuterol
• C. Administration of amiodarone
• D. Percutaneous pacing

Answer: (A)

In severe hyperkalemia with metabolic acidosis, the immediate goal is to protect the heart from the dangerous electrical effects of potassium. Calcium gluconate temporarily stabilizes the cardiac cell membranes, raising the threshold for depolarization and reducing the risk of life‑threatening arrhythmias, even before potassium is lowered. This membrane stabilization buys critical time while you initiate others steps to shift potassium into cells and remove it from the body. Nebulized albuterol and bicarbonate can help move potassium intracellular and correct acidosis, but they don’t provide the immediate protection the heart needs. Amiodarone or pacing is reserved for specific arrhythmias or bradycardia, not the initial priority in a patient with marked hyperkalemia. So the priority is to administer calcium gluconate to stabilize the myocardium.