Hyperkalemia treatment includes which of the following?

• A. D5W with regular insulin and Kayexelate
• B. Normal saline alone
• C. Potassium supplements
• D. Calcium gluconate only

Answer: (A)

In hyperkalemia, you want to both move potassium into cells quickly and remove excess potassium from the body. Insulin, given with glucose, drives potassium into cells by stimulating the Na+/K+-ATPase pump, which lowers the extracellular potassium level rapidly. Including dextrose prevents the insulin-induced drop in blood sugar. Adding a potassium-binding resin like Kayexelate in the gut helps remove potassium from the body over time by exchanging sodium for potassium in the colon, increasing fecal potassium excretion. So using insulin with glucose for a quick shift plus Kayexelate for ongoing removal effectively lowers potassium in the short and longer term.

Normal saline alone won’t reduce extracellular potassium; it’s mainly for fluid management and won’t address the potassium level. Potassium supplements would worsen hyperkalemia. Calcium gluconate stabilizes cardiac membranes to protect the heart but does not decrease potassium levels, so it’s a temporary safety measure rather than a definitive treatment.