🏥 USMLE Exam Prep

A 72-year-old male with chronic kidney disease stage 4 presents for routine follow-up. Labs show potassium 6.3 mEq/L. He denies palpitations, weakness, or other symptoms. His ECG shows no peaked T waves or other abnormalities. Which of the following is the most appropriate initial treatment for his hyperkalemia?

A Intravenous calcium gluconate
B Intravenous insulin and dextrose
C Oral sodium polystyrene sulfonate
D Intravenous furosemide

✓ Correct Answer: Option C

For asymptomatic hyperkalemia without EKG changes, agents that remove potassium from the body, such as oral sodium polystyrene sulfonate or patiromer, are appropriate. Calcium gluconate stabilizes cardiac membranes, and insulin/dextrose shifts potassium intracellularly.

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