What should be administered to a patient with end stage renal failure and suspected hyperkalemia?

In the context of treating a patient with end-stage renal failure who is suspected of having hyperkalemia, administering sodium bicarbonate serves a specific therapeutic role. Hyperkalemia can lead to dangerous cardiac conditions, and sodium bicarbonate helps to shift potassium from the extracellular space back into the cells. This can reduce the immediate levels of potassium in the blood, effectively helping to mitigate the risks associated with elevated potassium levels, such as cardiac dysrhythmias.

Additionally, sodium bicarbonate may also help to counteract acidosis, which can be present in patients with renal failure and is often associated with hyperkalemia. This dual effect makes sodium bicarbonate a valuable choice in this scenario as it provides both potassium reduction and systemic alkalinization.

The other options are not as suitable for the immediate management of hyperkalemia in this context. Sodium chloride would not directly address potassium levels. Administering potassium chloride would actually worsen hyperkalemia rather than help, and while calcium gluconate is often used in severe cases to stabilize cardiac membranes, it does not actually lower serum potassium levels. Thus, sodium bicarbonate is the most appropriate choice in this scenario.