Which of the following are commonly used to acutely lower serum potassium in hyperkalemia?

• A. Potassium-sparing diuretics
• B. Calcium channel blockers
• C. Saline infusion
• D. Insulin with glucose, albuterol, calcium gluconate, and diuretics

Answer: (D)

In acute hyperkalemia, the priority is to protect the heart while rapidly moving potassium into cells and preparing for its removal from the body. Calcium gluconate is given to stabilize the cardiac membrane, reducing the risk of dangerous arrhythmias even before potassium levels fall. To lower potassium quickly, insulin with glucose drives potassium into cells, and a beta-2 agonist like albuterol also shifts potassium intracellularly. At the same time, a diuretic helps promote renal excretion of potassium, helping to remove it from the body. This combination addresses all three goals—membrane stabilization, rapid intracellular shift, and elimination—making it the most effective acute strategy.

Potassium-sparing diuretics would actually raise potassium levels, not lower them. Calcium channel blockers do not have a reliable rapid effect on serum potassium. Saline infusion can help with volume status but does not acutely reduce potassium by itself.