After calcium gluconate, which treatments are given to actually decrease the potassium in hyperkalemia?

• A. IV regular insulin with dextrose, sodium polystyrene sulfonate, and hemodialysis
• B. Oral sodium bicarbonate
• C. Albuterol inhalation only
• D. Intravenous calcium chloride

Answer: (A)

After stabilizing the heart with calcium, the aim is to actually lower the potassium level. The best approach combines shifting potassium into cells and removing it from the body. IV regular insulin with dextrose drives potassium from the extracellular space into cells, lowering serum potassium; sodium polystyrene sulfonate binds potassium in the gut to increase its excretion in stool; and hemodialysis physically removes potassium from the bloodstream, which is highly effective, especially in renal failure or severe cases. Calcium gluconate was given to protect the heart, not to reduce potassium itself. Other options can help in certain situations (like bicarbonate for acidosis or albuterol as an added shift agent), but they’re not as consistent or rapid as the combination of insulin with glucose, a potassium-binding resin, and dialysis.