رجل عمره ٦٦ سنة عنده فشل كلوي مزمن، فاته الغسيل الكلوي مرتين، وجاء بضعف عام. البوتاسيوم ٦٫٨ ملمول/لتر، والتخطيط يظهر موجات T مدببة، والنبض ٥٤. الطبيب كتب عدة أدوية. أيها يُعطى أولاً؟

A 66-year-old man with chronic kidney failure missed dialysis twice and presents with generalised weakness. Potassium is 6.8 mmol/L, the ECG shows peaked T waves and HR is 54. The doctor orders several drugs. Which is given first?

1. Short-acting insulin with glucose
2. An oral potassium binder
3. IV calcium gluconate
4. Nebulised salbutamol

Answer: C) IV calcium gluconate. IV calcium comes first because it stabilises the myocardial membrane within minutes and protects against arrhythmia, though it does not lower potassium. Insulin-glucose and salbutamol then shift potassium into cells, followed by removal from the body.