How to Use Normal Saline for Hyperkalemia

Some people say you should use normal saline in a patient who is hyperkalemic because LR has K in it and normal saline doesn't. But the concentration of potassium in LR is four mille quivalents per liter, so if a patient has a K higher than four, LR will bring it down. It turns out actually that if you give people normal saline and you give other people LR, guess whose potassium ends up higher? The people getting the normal saline. Why? Because they get acidotic, they get a metabolic acidosis from the normal saline and that causes potassium to shift out of cells. So fluids should be administered with the same caution that is used with any intravenous