During cardiac arrest due to hyperkalemia, which therapy is preferred for rapid shift of potassium?

• A. Sodium bicarbonate
• B. Nebulized albuterol
• C. Glucose and insulin
• D. Calcium gluconate

Answer: (A)

When hyperkalemia causes cardiac arrest, the aim is to move potassium from outside the cells into the cells quickly to reduce the dangerous extracellular potassium level. Insulin, given with glucose, drives potassium into cells by activating the Na+/K+-ATPase pump, and its effect happens rapidly, making it the best option for a fast potassium shift. Nebulized albuterol can also shift potassium but its response is variable and it can cause tachycardia; sodium bicarbonate can help potassium shift, particularly if acidosis is present, but its effect is slower and less predictable in an emergent setting. Calcium gluconate doesn’t lower potassium; it stabilizes the heart muscle to protect against arrhythmias while other measures lower potassium. So the fastest, most reliable way to shift potassium in this scenario is glucose with insulin.