A 71-year-old man with chronic kidney disease and heart failure presents with weakness and nausea.
He recently completed treatment for a gastrointestinal illness that caused dehydration.
His medicines include ramipril, spironolactone, bisoprolol and furosemide.
His pulse is 48 beats/min and his blood pressure is 102/64 mmHg.
| Test | Result | Reference range |
|---|---|---|
| Potassium | 6.8 mmol/L | 3.5–5.3 mmol/L |
| Creatinine | 246 µmol/L | 60–110 µmol/L |
A 12-lead ECG is shown below.
After emergency stabilisation, which preventive intervention is most appropriate to reduce early recurrence?
The ECG shows toxic effects of severe hyperkalaemia, including peaked T waves, P-wave attenuation and QRS widening. Following urgent membrane stabilisation and potassium-lowering treatment, spironolactone should be withheld and renal function and potassium reviewed before any cautious reconsideration. Immediate reintroduction of a potassium-sparing agent would create a high risk of recurrence while kidney function remains impaired.
