5 Versus 10 Units of Insulin in Hyperkalemia Management

Inclusion Criteria: * Hyperkalemia patients with lab potassium levels equal to or more than 5.5 mEq/L (≥ 5.5 mEq/L)+. * Adult: age 18 years or more. * Agreed to participate in the study. * If an investigator decides to start anti-hyperkalemia medications based on the VBG/ABG patient can be enrolled but if the main laboratory value is less than 5.5 mEq/L patients will be excluded Exclusion Criteria: * Cardiac arrest * Hyperglycemia with random blood sugar 20 mmol/L (13) or with acute diabetic complications like Diabetic Ketoacidosis / Hyperosmolar Hyperglycemic State. * Hypoglycemia with random blood sugar (RBS) ≤ 3.89 mmol/l in Diabetic patients and less than 3 mmol/l in non-diabetic patients. * Allergies for any medication in the protocol. * Pregnancy. * Hemolyzed potassium level as reported by the main lab. * Hemolysis, Tumor lysis syndrome, or Rhabdomyolysis due to the ongoing release of potassium. * Acidosis with a pH less than 7.1 will require Sodium bicarbonate (NaHO3). * A patient who will need urgent Furosemide (Lasix), and or dialysis during the study period of 2 hours. * Refused to participate.