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-Consider discontinuing ACE inhibitors, angiotensin II receptor blockers, beta-blockers, potassium sparing diuretics. -Calcium gluconate (10% sln) 10-30 mL IV over 2-5 min; second dose may be given in 5 min. Contraindicated if digoxin toxicity is suspected. Keep 10 mL vial of calcium gluconate at bedside for emergent use. -Sodium bicarbonate 1 amp (50 mEq) IV over 5 min (give after calcium in separate IV).

-Regular insulin 10 units IV push with 1 ampule of 50% glucose IV push. -Kayexalate 30-45 gm premixed in sorbitol solution PO/NG/PR now and in q3-

4h prn, up to 5 times per day. -Furosemide 40-80 mg IV, repeat prn.

-Consider emergent dialysis if cardiac complications or renal failure.

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