In acute hyperkalemia, after stabilizing the myocardium with calcium, which intervention is used to shift potassium intracellularly?

• A. Insulin with glucose
• B. Sodium polystyrene sulfonate
• C. Loop diuretic
• D. Aluminum hydroxide

Answer: (A)

Shifting potassium into cells is accomplished by insulin activating the Na+/K+-ATPase pump, which moves potassium from the extracellular space into cells and rapidly lowers serum potassium. Giving insulin with glucose ensures this effect happens quickly while preventing hypoglycemia from the insulin. After calcium has stabilized the myocardium to protect the heart, this intracellular shift is the fast-acting step to reduce dangerous potassium levels.

Sodium polystyrene sulfonate lowers potassium by binding it in the gut and removing it from the body, which is slower and not an intracellular shift. Loop diuretics can promote renal potassium excretion but depend on kidney function and are not as immediate. Aluminum hydroxide has no role in potassium management.