This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Cardiopulmonary Cerebral Resuscitation, Subject name: Anaesthesia
First line of management for hyperkalemia presenting with ECG changes is: 
Select and explain. 
A. Glucose insulin drip, B. Calcium gluconate, C. Haemodylasis, D. Potassium chelating resins
B: Calcium gluconate
Answer: B: Calcium gluconate 
Explanation: Calcium gluconate should be used as a first-line agent in patients with ECG changes or severe hyperkalemia to protect cardiomyocytes. Insulin and glucose combination is the fastest acting drug that shifts potassium into the cells. Hemodialysis is the most effective and reliable method to remove potassium from the body.