Which medication is listed as the second step in the hyperkalemia treatment sequence?

• A. CALCIUM CHLORIDE 1 g slow IVP/IO
• B. SODIUM BICARBONATE 50 mEq slow IVP/IO
• C. ALBUTEROL 2.5 mg in 3 mL continuous SVN
• D. Insulin with glucose

Answer: (A)

When hyperkalemia is treated, protecting the heart from the elevated potassium is the immediate priority. Calcium given intravenously stabilizes the cardiac cell membranes, raising the threshold for excitability so the heart is less prone to dangerous arrhythmias as other therapies take effect. This stabilization happens quickly, buying time for treatments that actually lower or relocate potassium in the body to work.

Calcium chloride does not remove potassium itself; its role is to guard the myocardium right away. After the heart is stabilized, you then move on to therapies that shift potassium back into cells or remove it from the body (such as insulin with glucose, albuterol, or bicarbonate), which explains why calcium is used early in the sequence but not a potassium-lowering step by itself.