امرأة عمرها ٦٦ سنة عندها مرض كلى مزمن في المرحلة الرابعة، تأخذ ليسينوبريل وسبيرونولاكتون. تشتكي ضعفاً عاماً وخفقاناً. النبض ٤٨، والضغط ١١٨/٧٠، والبوتاسيوم ٧٫٠، والتخطيط يظهر موجات T مدببة واتساع QRS. ما أول دواء يتوقعه الممرض؟

A 66-year-old woman with stage 4 CKD takes lisinopril and spironolactone. She reports generalised weakness and palpitations. HR 48, BP 118/70, potassium 7.0, and the ECG shows peaked T waves and QRS widening. Which drug does the nurse expect first?

1. IV calcium gluconate to protect the heart muscle
2. A unit of blood for kidney-related anaemia
3. Oral sodium bicarbonate with a banana-rich meal
4. High-dose IV furosemide as the first step now

Answer: A) IV calcium gluconate to protect the heart muscle. With ECG changes, IV calcium is given first to stabilise the cardiac membrane, then insulin with glucose to shift potassium into cells, then removal by binders or dialysis. Potassium-raising drugs are stopped.