What is the last-line drug combination for life-threatening dysrhythmias caused by hyperkalemia?

• A. Insulin with glucose
• B. Albuterol inhalation
• C. Calcium gluconate
• D. Sodium bicarbonate and calcium chloride

Answer: (D)

When hyperkalemia reaches a level that causes life-threatening dysrhythmias, the goal is to protect the heart first while you begin to move potassium into cells and prepare for removal. The combination of sodium bicarbonate and calcium chloride serves this dual purpose. Calcium chloride quickly stabilizes the cardiac membrane, raising the threshold for depolarization and reducing excitability so dangerous rhythms are less likely to occur. Sodium bicarbonate helps correct acidosis and shifts potassium back into cells by increasing the blood pH, which promotes intracellular movement of potassium and lowers the serum potassium level. Using them together addresses both the immediate electrical instability and the ongoing potassium burden, which is why this pair is chosen as a last-resort measure when initial therapies haven’t controlled the rhythm disturbances and the patient remains at risk for collapse.