In crush injuries with severe hyperkalemia, which emergency treatment is NOT recommended?

• A. Administer aggressive IV fluids
• B. Limit fluids
• C. Begin potassium-binding therapy
• D. Prepare for dialysis

Answer: (B)

In crush injuries with severe hyperkalemia, the priority is to protect kidney function and rapidly reduce circulating potassium. The main idea is that aggressive IV fluids are essential to maintain renal perfusion, flush out potassium and myoglobin, and prevent acute kidney injury from pigmented necrosis. Limiting fluids would do the opposite: it lowers urine output, worsens renal injury, and hampers potassium clearance, increasing the risk of dangerous heart rhythm problems. The other options fit into a multimodal emergency approach: giving fluids to support the kidneys, using potassium-binding therapy to help reduce potassium levels (as part of the overall plan), and preparing for dialysis if potassium remains high or kidney function is failing.