The electrocardiogram (ECG) is the first thing to consider when determining the appropriate order of medications for a hyperkalemic patient. Various, predictable ECG abnormalities directly correlate with the amount of serum potassium, as illustrated in Table. The ECG is your safety net,particularly because one commom cause of elevated serum potassium is extra-vitro hemolysis. This “pseudohyperkalemia” occurs for several reasons: blood is drawn with a small bore needle,blood is drawn either too fast or forcefully hits the side of the blood vial,or blood vials are agitated vigorously or dropped prior to testing. In these instances, red blood cells lyse, releasing potassium, causing the potassium Lever to rise in the tube. This is not a laboratory error; the potassium lever is, infact,high in the tube, but not the patient. The ECG would alert you to