Key messages

• Because the kidney is responsible for 90 per cent of potassium excretion, most true hyperkalemia results from renal insufficiency

• Glucose and insulin reduce plasma potassium; insulin promotes potassium entry into cells by mechanisms separate from glucose entry, and glucose is required to prevent hypoglycemia

• Sodium bicarbonate promotes entry of potassium into cells by reducing hydrogen-potassium exchange

• Promotion of a diuresis with loop diuretics or thiazides will increase potassium excretion.

• Calcium salts should be reserved for patients with severe hyperkalemia or life-threatening dysrhythmias.

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