Q: Why it is important to administer calcium in symptomatic hyperkalemia while treating it with other modalities like insulin, glucose, bicarb., albuterol or cation exchange resin?


Answer: All other modalities take its "own sweet time" to exert effect, like even insulin and glucose  'combo' will take 30 to 60 minutes to act. If patient start showing signs of EKG changes like flattening of P waves or widening of QRS, calcium should be administered to have cardiac protection. Also, be aware of the danger of using calcium along with bicarbonate.  Administering bicarbonate after calcium, may bind calcium and may render it ineffective. This is why we don't prepare "bicarb drip" in LR (Lactated Ringer’s). Preferably, if required sodium bicarbonate should be given before calcium.