Perioperative care: emergency treatment of hyperkalaemia: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Perioperative care: emergency treatment of hyperkalaemia

Sample item

A patient with postoperative acute kidney injury has a potassium of 7.2 mmol/L with peaked T waves and a widened QRS complex. Which drug is given first?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Intravenous calcium gluconate

With ECG changes, intravenous calcium stabilises the myocardial membrane within minutes, though it does not lower potassium. Insulin with dextrose and salbutamol then shift potassium into cells, and definitive removal is by resins, diuretics or dialysis.

Option by option

  • A. Intravenous insulin with dextrose

    Insulin with dextrose lowers potassium by shifting it into cells but does not protect the myocardium at once.

  • B. Nebulised salbutamol

    Salbutamol shifts potassium into cells and is an adjunct after membrane stabilisation.

  • C. Intravenous calcium gluconate (correct)

    Correct. Calcium protects the heart immediately when ECG changes are present.

  • D. Intravenous sodium bicarbonate

    Sodium bicarbonate has a limited effect and is considered mainly in acidosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Intravenous calcium gluconate. With ECG changes, intravenous calcium stabilises the myocardial membrane within minutes, though it does not lower potassium.

Why is "Intravenous insulin with dextrose" not the answer?

Insulin with dextrose lowers potassium by shifting it into cells but does not protect the myocardium at once.

Why is "Nebulised salbutamol" not the answer?

Salbutamol shifts potassium into cells and is an adjunct after membrane stabilisation.

Why is "Intravenous sodium bicarbonate" not the answer?

Sodium bicarbonate has a limited effect and is considered mainly in acidosis.

What concept does this question test?

It tests Perioperative care: emergency treatment of hyperkalaemia in General Surgery. Insulin with dextrose and salbutamol then shift potassium into cells, and definitive removal is by resins, diuretics or dialysis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Perioperative care: emergency treatment of hyperkalaemia?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.