In a patient with mesenteric ischemia who has extensive bowel resection and presents with hyperkalemia (K 7.6) and impaired renal function, which immediate treatment is indicated?

• A. IV calcium chloride and Blood Products
• B. Transcutaneous pacing and Blood Products
• C. Decrease of PEEP
• D. Administration of IV atropine

Answer: (A)

When potassium is that high and kidney function is poor, the immediate priority is to protect the heart from hyperkalemia’s effects. IV calcium stabilizes the cardiac membrane, reducing excitability and preventing life‑threatening arrhythmias as potassium remains elevated. Calcium chloride (or calcium gluconate) acts right away to raise the threshold for depolarization, buying time while other treatments lower and remove potassium.

After calcium, you would move on to shifting potassium into cells (insulin with glucose, possibly bicarbonate if acidotic, and beta-agonists) and then removing it (dialysis is often needed in renal failure). Other options don’t address the immediate danger to the myocardium from severe hyperkalemia.