The emergency management of severe hyperkalemia aims to stabilize the cardiac membrane and shift potassium intracellularly. Administration of insulin and glucose is critical because insulin drives potassium into cells by stimulating the Na+/K+ ATPase pump, rapidly reducing serum potassium levels. Glucose is given simultaneously to prevent hypoglycemia caused by insulin. This approach provides a temporary but effective measure to lower potassium while definitive treatments are initiated.

Key point: Insulin with glucose quickly reduces serum potassium by intracellular shifting, reducing the risk of life-threatening cardiac arrhythmias.

Reference: Harrison's Principles of Internal Medicine, Jameson et al., 20th Edition.