For hyperkalemia in acute renal failure, which treatment regimen is used?

• A. Hypertonic glucose, insulin infusions, and sodium bicarbonate
• B. Potassium supplements
• C. IV saline with no insulin
• D. Calcium gluconate only

Answer: (A)

In hyperkalemia from acute renal failure, the priority is to rapidly lower the outside potassium by moving it into cells and correcting acidosis. Insulin drives potassium into cells, and when given with glucose it lowers serum potassium quickly while avoiding hypoglycemia. Adding sodium bicarbonate helps if there is acidosis, which often accompanies renal failure and also promotes shifting potassium into cells. Hypertonic glucose is included specifically to prevent hypoglycemia from the insulin infusion. This combination rapidly reduces extracellular potassium, which is crucial to protect the heart from arrhythmias.

Potassium supplements would worsen the problem. IV saline without insulin won’t move potassium into cells, so it doesn’t address the immediate threat. Calcium gluconate stabilizes cardiac membranes but does not reduce potassium levels by itself, so it’s insufficient as the sole treatment for hyperkalemia. Therefore, the regimen that best treats acute hyperkalemia in renal failure combines hypertonic glucose, insulin, and sodium bicarbonate.