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Lesson

Calcium for HyperK ECG Toxicity

10 min Meds & Pharma Skip to quiz

Objective: Use calcium for heart toxicity from high potassium: a wide QRS, a sine wave, or unstable bradycardia. It is not for every peaked T wave in a stable patient, and it is not a routine add-on for every dialysis patient. Your protocol card sets the amount.

Why this matters

Calcium protects the heart membrane when high potassium is toxic to the heart. That picture is a wide QRS, a sine wave, or unstable bradycardia on the hyperkalemia pathway. It buys time. It does not lower the potassium in the body. It is not for every peaked T wave in a stable patient. Your protocol card sets the amount.

Key points
  • Get a 12-lead. Peaked T waves alone, in a stable patient, are not an automatic calcium dose.
  • The story matters: missed dialysis, crush injury, an ACE inhibitor plus a potassium-sparing drug, or recent succinylcholine.
  • Do not give calcium and bicarbonate in the same line. Flush between them.

Clinical sequence

  1. Get a 12-lead. Peaked T waves alone, in a patient who is talking and well perfused, are not an automatic calcium dose. Treat the patient and follow the protocol threshold.
  2. Use the story. Missed dialysis, crush, an ACE inhibitor plus a potassium-sparing drug, or recent succinylcholine. An unstable missed-dialysis patient with a sine wave needs membrane protection plus the rest of ALS care. Do not wait for a lab.
  3. Do not mix calcium with bicarbonate in the same line. They form a solid precipitate. Flush between them. Calcium chloride and calcium gluconate are different concentrations. Your protocol chooses which salt and how much. This site does not list milligrams or grams.

Teaching points

  • Protect the membrane: calcium. Your protocol chooses the salt and the amount. Calcium does not remove potassium.
  • Shift potassium, on a typical ALS ambulance: nebulized albuterol if your protocol includes it. Insulin with dextrose is usually a hospital step, or a written protocol step. Most 911 crews do not mix insulin on scene. Bicarbonate only if the protocol names it.
  • Remove potassium: dialysis. Go to a hospital that can provide it.
  • Digoxin toxicity is a caution for calcium in some teaching. If the story is digoxin, call online medical control.

Common errors

  • Giving calcium for one peaked T wave in a talking, well-perfused patient because the monitor said high potassium.
  • Giving amiodarone for sine-wave bradycardia.
  • Running calcium and bicarbonate through the same line so they precipitate.

Practice

One-minute check

With a partner, say calcium yes or no, and what else you do: (1) peaked T waves, alert, blood pressure 130; (2) a sine wave, unstable, missed dialysis.

Related: Hyperkalemia ECG, Dialysis.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Calcium in hyperK (high potassium):
2. Sine-wave, crashing, missed dialysis:
3. Calcium chloride vs gluconate:
4. Peaked T, talking, stable:
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