Medication*	Dosage	Onset	Length of effect	Mechanism of action	Cautions
Calcium gluconate	10 to 20 mL of 10 percent solution IV over two to three minutes	Immediate	30 minutes	Protects myocardium from toxic effects of calcium; no effect on serum potassium level	Can worsen digoxin toxicity
Insulin	Regular insulin 10 units IV with 50 mL of 50 percent glucose	15 to 30 minutes	Two to six hours	Shifts potassium out of the vascular space and into the cells; no effect on total body potassium	Consider 5 percent dextrose solution infusion at 100 mL per hour to prevent hypoglycemia with repeated doses. Glucose unnecessary if blood sugar elevated above 250 mg per dL (13.9 mmol per L)
Albuterol (Ventolin)	10 to 20 mg by nebulizer over 10 minutes (use concentrated form, 5 mg per mL)	15 to 30 minutes	Two to three hours	Shifts potassium into the cells, additive to the effect of insulin; no effect on total body potassium	May cause a brief initial rise in serum potassium
Furosemide (Lasix)	20 to 40 mg IV, give with saline if volume depletion is a concern	15 minutes to one hour	Four hours	Increases renal excretion of potassium	Only effective if adequate renal response to loop diuretic
Sodium polystyrene sulfonate (Kayexalate)	Oral: 50 g in 30 mL of sorbitol solution Rectal: 50 g in a retention enema	One to two hours (rectal route is faster)	Four to six hours	Removes potassium from the gut in exchange for sodium	Sorbitol may be associated with bowel necrosis. May lead to sodium retention