A girl presented with severe hyperkalemia and peaked T waves on ECG. Fastest way of shifting potassium intracellularly is-
(reference : Emergency management of acute hyperkalemia Medication Response type Onset of action Duration of action Mechanism of action Expected decrease in potassium level Calcium gluconate rapid 1-2 min 30-60 min Protect cardiomyocytes 0.5-1.5 mEq/L Glucose + insulin intermediate 10-20min 2-6 hours Shift potassium intracellularly 0.5-1.5 mEq/L (dose dependent) Beta-agonists intermediate 3-5min 1-4 hours Shift potassium intracellularly Sodium bicarbonate (only in patients with metabolic acidosis, bicarbonate < 22mEq/L) intermediate 30-60min 2-6 hours Shift potassium intracellularly (questionable effect) Exchange resin delayed 2-6hours 4-6 hours Elimination of potassium from the body Furosemide delayed 5-30 min 2-6 hours Elimination of potassium from the body Hemodialysis delayed immediate Elimination of potassium from the body 1mmol/L in the first 60 min and total of 2mmol/l by 180 min
Calcium gluconate IV
Oral resins
Insulin + glucose
Sodium bicarbonate
Fluid and electrolytes