Calcium gluconate does not affect the serum potassium level but rather counteracts the myocardial effects of hyperkalemia. Reduction in an elevated serum potassium level, however, is impoant to avoid the cardiovascular complications that ultimately culminate in cardiac arrest. Kayexalate is a cation exchange resin that is instilled into the gastrointestinal tract and exchanges sodium for potassium ions. Its use is limited to semiacute and chronic potassium elevations. Sodium bicarbonate causes a rise in serum pH and shifts potassium intracellularly. Administration of glucose initiates glycogen synthesis and uptake of potassium. Insulin can be used in conjunction with this to aid in the shift of potassium intracellularly