Do you administer calcium to patients with K > 6.5 without EKG changes?

No. But our ER does as a reflex and I don't have a problem with that. It used to drive me nuts bc it sent the wrong message, as though Ca lowers [K] level (of course it does not, it just decreases cardiac effect). But you don't know how fast they are being seen, how fast they will get treated, so I ...

It’s not necessary but I realize that the expectation from staff nurses and physicians especially in the ER is to do so. Most do it in a automated reactive fashion.

How much of that calcium combines with high phosphorus is a consideration in patients with CKD 4 and higher! Are we doing more harm by giving iv calcium gluconate?