Had a pt with HHS, sugar 1300, pH 7.2, K 6.5, Cr. 3, mild peaked t's on EKG. In addition to fluids, insulin gtt, I gave him some calcium gluconate as well. Otherwise stable gentleman. Spoke with the IM admitting resident who wants me to give him...kayexalate? 1. It strikes me as odd, in a pt who is at risk for total body K depletion, that the medicine resident really wants to add kayexalate to the mix. Hydration and insulin alone should resolve the acidosis, re-distribute the K, increase the urine output without risking bottoming out the K. 2. It also strikes me as odd that every medicine resident I talk to about hyperkalemia do not immediately ask about the immediate lowering/redistribution agents and cardioprotecting agents....they ask about the kayexalate. I send you to this link for further review: http://www.asn-online.org/press/files/JASN_Sterns_study.pdf I tried my best to convince him (tersely) that this was unwarranted, without much avail. He came by the ED and wrote for a dose of kayexalate on the pt's chart which just infuriated me more. Am i crazy or what?