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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#24 (reveal difficulty score)
A 57-year-old man is brought to the emergency ...
Intravenous calcium gluconate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: renal cardio inc

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 +3  upvote downvote
submitted by โˆ—welpdedelp(270)
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Ca Gluconate must be given immediately if K > 6.5; think of it as "no point in hydrating or pushing K into cells with insulin if they will die rn of an arrhythmia"

Ca will stabilize immediately, which is why its initial tx.

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ronabobonafofona  I also generally use "are there ECG changes?" as a good marker of it you need to give it or not. +



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submitted by โˆ—beeip(141)
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Should be 50:50 here between CaGluc vs. Insulin/Glucose. Peaked T's is a hint that we need to protect myocardium right now.

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lindasmith462  I mean I get that Calcium is the right answer (it acts the fastest in 1-3 min) but its supper annoying because you'd be giving insulin and glucose AT THE SAME TIME too - they just take longer to work once you put them in.... +1



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submitted by โˆ—step_prep7(71)
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  • Patient has missed several days of dialysis and was found down in his house (which can lead to rhabdomyolysis), giving this patient 2 reasons to have metabolic acidosis with hyperkalemia
  • Hyperkalemia can lead to abnormal heart rhythms that can lead to patient death, so patients who have hyperkalemia with one of the following three features should first receive calcium gluconate to stabilize the cardiac membrane prior to trying to reduce potassium levels: (1) Potassium > 7.0 (2) ECG changes (Peaked T waves, PR prolongation and QRS widening, disappearance of P wave) (3) Rapidly rising potassium due to tissue breakdown or tumor lysis syndrome
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