INS and Adrenal insufficiency: 3 If ECG changes are present, the immediate step of administering cardiac membrane-stabilizing agent such as calcium gluconate 10% followed by potassium lowering agents, such as albuterol, insulin and dextrose, furosemide and sodium polystyrene sulfonate, is warranted. 1,3 In our patient, hyperkalemia was caused by the underlying adrenal insufficiency exacerbated by missed doses of hydrocortisone due to vomiting and acute illness.