Inclusion Criteria:  adult patients serum potassium level >5.9 mEq/L  Exclusion Criteria:  Pseudohyperkalemia:  Hemolysis of blood sample Thrombocytosis > 10*6 /mm3 Hyperleukocytosis > 10*5/mm3 Mechanical Trauma during Venipuncture Fist clenching during blood drawing Tourniquet time > 1 minute  Diabetes acute complications  DKA Hyperosmolar Hyperglycemic Syndrome Insulin-dependent diabetes mellitus ( if insulin is taken recently) Pregnant women Hyperthyroidism Hemodynamic instability Pacemakers if providing impulses (demand pacemakers that are not firing right now are included) Atrial fibrillation or any other arrhythmia Baseline tachycardia >120 bpm Acute exacerbations of HF Patients expected to require emergency intubation and ventilation Patients expected to require dialysis within the first 60 minutes Patients with hypersensitivity to the medication Patients with Acute Coronary Syndrome Patients on beta-blockers / beta-agonists or anti-arrhythmic drugs Patients with severe dyspnea or hypoxia SpO2 <90%