INS and periodic paralysis: Other causes of hyperkalemia from potassium shifts include severe exercise, hyperkalemic periodic paralysis, cardiac surgery, insulin antagonists (somatostatin and diazoxide), hypertonic solutions (hypertonic saline and hypertonic mannitol), digitalis overdose, succinylcholine, arginine hydrochloride, lysine hydrochloride, and fluoride poisoning (1, 2).