How do dextrose 50-50 decrease the potassium level in renal failure?

i am caring for a patient with an increased creatinine level of 2000 and a potassium level of 7.83, the pt is a candidate for a stat dialysis, for the meantime the dr ordered for a calcium gluconate via iv bolus then several doses of d50-50 to lessen the potassium, how does it happen?what is the role of calcium gluconate?

Elevated potassium causes the cardiac muscle cells to be unstable electrically and can cause life threatening arrythmias. The immediate goal pending removal of potassium (via dialysis) is to try to lower the level of serum potassium and stabilize the cardiac muscles cells.

The role of IV calcium gluconate is to attempt to stabilize the cardiac muscle cells. It does nothing to the potassium levels in the blood.

There are a couple ways to lower the life-threatening level of potassium in the blood. One way is to give dextrose (which is broken down to glucose), and it is often given with insulin. Insulin drives glucose into the cells of the body along with potassium using the sodium-potassium-ATPase enzyme. Thus the extracellular potassium becomes intracellular (pushed inside cells), and lessens the effect on cardiac muscle electrical activity. Ultimately this does not remove potassium from the body either, but lowers the amount of potassium in the blood until other means are used to eliminate it.