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6 month-old, 8 kg female with sagittal craniosynostosis is presenting for
repair. During intraoperative management, the patient is given 20 mL/kg of
packed red blood cells for intraoperative blood loss repletion. An ABG
demonstrates a pH of 7.21. There is an elevation of T-wave amplitude noted on
the EKG. What would the BEST intervention to return the EKG to normal in this
setting?

a) Administer Glucose

b) Administer Calcium Gluconate

c) Hyperventilate

d) Administer Insulin

e) Administer Sodium bicarbonate
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==Answer==
Answer b. This patient has just received a blood transfusion, which is a risk
factor for hyperkalemia. The EKG finding of enlarging T-waves is an early sign of
hyperkalemia. All of the possible answer choices are appropriate measures to
address the elevated serum potassium value, but only one of hyperkalemia, but
only administration of calcium is believed to stabilize cardiac membranes and
decrease the risk of lethal dysrhythmia.
==Notes==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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