<prompt> A girl presented with severe hyperkalemia and peaked T waves on ECC. Most rapid way to decrease serum potassium level:Calcium gluconate IVOral resinsInsulin glucoseSodium bicarbonate  <response>: Ans. c. Insulin glucose Administering insulin and glucose are the most rapid way to decrease serum potassium level.Intravenous insulin is the fastest way to lower serum potassium levels.Intravenous calcium gluconate is the first drug to he administered in a patient with hyperkalemia having ECG abnormalities. It stabilizes the myocardium immediately. It acts within minutes and is characterized by improvement in ECG appearance. Complaints of muscle weakness, nausea, vomiting and fatigue and ECG showing tall peaked T waves, prolonged PR interval, wide QRS and absent P wave is suggestive of Hyperkalemia, Beta-agonists are used in the management of hyperkalemia, not the beta-blockers.ECG changesHypokalemiaHyperkalemia ST depressionQ Flattened or inverted T waveQ Prominent U waveQ Prolonged PR intervalQ Rarely S-A blockEarly Increased T wave amplitudeQ Peaked T wavesQLater with severe degrees of hyperkalemia Prolonged PR intervalQ Prolonged QRS durationQ AV conduction delayQ Loss of P wavesQ Sine wave patternQ Ventricular fibrillation or asystoleQHyperkalemiaHyperkalemia is defined as plasma K conc. 5.0 mmolL, but every case of Hyperkalemia doesnt require treatment.The management strategy of Hyperkalemia depends upon:Plasma K concentrationAssociated muscular weaknessChanges on ECGTreatment of Hyperkalemia is required in following cases:Serum K 5 along with ECG manifestation of HyperkalemiaSerum K 6 even when ECG manifestation are not presentIn Hyperkalemia the treatment is directed atMinimizing membrane depolarizationRedistribution of potassium shifting of K back into cellsIncreased excretion of potassium Administration of calcium in the form of calcium gluconate, decreases membrane excitabilityQ Calcium directly reverses the effect of potassium on the cardiac conduction systemQ Administering insulin and glucose Alkali therapy with I.V. NaHCO3Q Beta2 adrenergic agonistQ When administered parenterally or in nebulized form, beta2 adrenergic agonist promote cellular uptake of KQ Cation exchange resinQ Sodium polystyrene sulfonate Diuretics Enhance K excretionQ Hemodialysis Most effective and rapid way of lowering plasma K conc.Q 