What is the recommended approach to electrolyte disturbances (potassium) during arrest?

• A. Address hyperkalemia or hypokalemia per ACLS guidelines, including calcium, insulin/dextrose or potassium supplementation; correct underlying causes; continuous monitoring.
• B. Ignore potassium abnormalities
• C. Use potassium supplementation only
• D. Administer bicarbonate only

Answer: (A)

Potassium imbalances can make the heart more irritable or less excitable, which is why they’re addressed during arrest as part of ACLS care. The best approach is to assess the potassium level and then treat accordingly, while also stabilizing the heart and fixing underlying causes and keeping a close eye on the patient.

If potassium is high, the priority is to stabilize the cardiac membranes first with calcium. After that, shift the potassium back into cells using insulin with glucose, and consider other measures like bicarbonate if acidosis is present or beta-agonists if needed. Simultaneously, identify and treat the underlying reason for the hyperkalemia and keep monitoring potassium and ECG constantly.

If potassium is low, correct it with appropriate potassium replacement, again with careful monitoring to avoid overcorrection or just overloading the patient, and address the underlying cause. Continuous monitoring of electrolytes and rhythm is essential throughout.

Choosing to ignore potassium, or to give potassium or bicarbonate alone without a tailored approach, would miss the specific needs dictated by the potassium level and could worsen the situation.