Calcium gluconate in hyperkalemia is indicated for which patients?

• A. All hyperkalemic patients
• B. Chronic kidney disease only
• C. Symptomatic patients or those with ECG changes to restore membrane excitability
• D. Asymptomatic with normal ECG

Answer: (C)

Calcium gluconate is used in hyperkalemia to stabilize cardiac cell membranes by increasing the threshold for depolarization, which helps prevent life-threatening arrhythmias as potassium levels are being lowered. It acts quickly but does not reduce the potassium level itself, so you provide it to protect the heart while you start other measures to lower potassium (such as insulin with glucose, beta-agonists, bicarbonate, or dialysis).

The best indication is for patients who are symptomatic or who show ECG changes indicating heightened risk of arrhythmias (for example, changes like tall peaked T waves or widening QRS). In asymptomatic patients with a normal ECG, calcium gluconate is not indicated because there’s no immediate threat to membrane excitability, and the focus is on lowering the potassium rather than stabilizing the membrane.