ROSH Geriatrics Practice Test

In the context of a 67-year-old woman presenting with peaked T waves on an EKG alongside a plasma potassium level of 4 mEq/L, the most appropriate treatment is calcium gluconate. Peaked T waves are typically indicative of hyperkalemia, although a potassium level of 4 mEq/L is within the normal range. This discrepancy suggests the possibility of a transient or false elevation in the patient’s potassium levels due to factors such as tissue injury, acidosis, or other underlying conditions.

Calcium gluconate is used in situations of hyperkalemia to stabilize the cardiac membrane against the potentially dangerous effects of elevated potassium levels. High potassium can lead to fatal cardiac arrhythmias, and calcium works rapidly to protect the heart muscle by antagonizing the effects of elevated serum potassium on cardiac tissue. It does not lower the potassium levels but significantly mitigates the risk of arrhythmias and cardiovascular complications associated with hyperkalemia.

In this case, while other options like albuterol, furosemide, and sodium polystyrene sulfonate may play roles in managing hyperkalemia by lowering potassium levels or promoting its excretion, the immediate need to protect the heart function in the setting of peaked T waves makes calcium glucon