Which of the following may be indicated for treatment of a hyperkalemic infant with significant cardiac arrhythmia?

• A. Calcium gluconate
• B. Sodium bicarbonate
• C. Sodium chloride
• D. Glucose solution

Answer: (A)

Stabilizing the heart muscle is the priority when a hyperkalemic infant has significant cardiac arrhythmia. Calcium gluconate rapidly stabilizes cardiac cell membranes, raising the threshold for excitability and reducing the risk of dangerous conduction disturbances like wide QRS complexes or arrest. It does not lower the potassium level itself, but it protects the myocardium long enough for treatments that actually reduce potassium to take effect, such as insulin with glucose, bicarbonate if acidosis is present, beta-agonists, or, in severe cases, dialysis.

Sodium bicarbonate can help shift potassium into cells, especially if acidosis is present, but it doesn’t provide immediate membrane stabilization. Sodium chloride doesn’t address the acute danger and can worsen potassium effects. Glucose solution alone won’t protect the heart or rapidly lower potassium; it’s a component of therapy (with insulin) to move potassium intracellularly, not a standalone fix for arrhythmia.