INS and Hyperkalemia: For example, at moderate hyperkalemia (~5.8 mEq/L), sinus node suppression produced junctional escape rhythm with atrial bigeminy, which resolved after hemodialysis.[5] At higher levels (~7.0 mEq/L), escape–capture bigeminy was observed, resolving with intravenous calcium and insulin-glucose therapy.[2] Even mild hyperkalemia has been associated with escape–echo bigeminy, indicating that small shifts in membrane excitability can unmask latent conduction abnormalities[8] (Table 1).