Calcium for HyperK ECG Toxicity
Objective: Give calcium a job: ECG toxicity (wide, sine, bradycardia in the right patient) — not a routine “renal” additive.
Why This Is Hard
Peaked T waves and someone wants calcium “just in case.” AHA 2025 special circumstances: calcium is for cardiotoxicity from hyperK (wide QRS, sine, unstable). It buys time. It does not fix the potassium.
- 12-lead. Peaked T alone in a stable patient is not automatically the crash syringe.
- Dialysis, crush, ACE-I plus K-sparing, succs history — the story matters.
- Do not mix calcium with bicarb in the same line. Flush.
Field Rules (Education)
- Stabilize: calcium (chloride vs gluconate is a protocol/concentration issue — they are not mL-for-mL the same). This site does not publish milligrams.
- Shift: insulin/dextrose, albuterol, bicarb in selected acidotic patients — protocol.
- Remove: dialysis. Destination.
- Digoxin toxicity is a caution for calcium in some teachings. OLMC if the story is dig.
Field Pitfalls
- Calcium for a single peaked T in a talking, well-perfused patient because the computer said “hyperK.”
- Amiodarone for sine-wave bradycardia.
- Same-line calcium and bicarb precipitate.
Practice
60-second drill
Partner: (1) peaked T, alert, BP 130; (2) sine wave, crashing, missed dialysis. Calcium yes/no.
Related: HyperK ECG, Dialysis.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- AHA 2025 Part 10: Special Circumstances — calcium for hyperK cardiotoxicity; shifting agents per protocol
- LITFL hyperK ECG — atlas, not a treatment guideline
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.