A 62-year-old man is suffering from arrhythmias on the night of his triple coronary bypass. Potassium has been administered. His urine output is 20 to 30 mL/h. Serum potassium level is 6.2. Which of the following medications counteracts the effects of potassium without reducing the serum potassium level?

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