All of the following are used in the management of hyperkalemia except: March 2007

Ans. D: I.V. KC1 infusion Causes of hyperkalemia include: Ineffective elimination from the body Renal insufficiency - Medication that interferes with urinary excretion: ACE inhibitors and angiotensin receptor blockers Potassium-sparing diuretics (e.g. amiloride and spironolactone) NSAIDs such as ibuprofen, naproxen, or celecoxib The calcineurin inhibitor immunosuppressants cyclosporin Trimethoprim Pentamidine - Mineralocoicoid deficiency or resistance, such as: Addison's disease Aldosterone deficiency Congenital adrenal hyperplasia Type IV renal tubular acidosis (resistance of renal tubules to aldosterone) - Gordon's syndrome ("familial hypeension with hyperkalemia") Excessive release from cells - Rhabdomyolysis, burns or any cause of rapid tissue necrosis, including tumour lysis syndrome Massive blood transfusion or massive hemolysis - Shifts/transpo out of cells caused by acidosis, low insulin levels, beta-blocker therapy, digoxin overdose, or the paralyzing anesthetic succinylcholine Excessive intake - Intoxication with salt-substitute, potassium-containing dietary supplements, or potassium chloride (KC1) infusion. ECG findings: With mild to moderate hyperkalemia, there is reduction of the size of the P wave and development of peaked T waves. Severe hyperkalemia results in a widening of the QRS complex, and the EKG complex can evolve to a sinusoidal shape. Treatment Calcium supplementation (calcium gluconate) Insulin intravenous injection along with dextrose to prevent hypoglycemia, will lead to a shift of potassium ions into cells, secondary to increased activity of the sodium-potassium ATPase. Bicarbonate therapy Salbutamol Sodium Polystyrene sulfonate.