Help understanding reason for meds
- 0Apr 12, '13 by <3_RNHi, I'm a fairly new nurse on a telemetry floor. I am not sure at the reasoning for some medications administered to a newly admitted pt.
The pt was ad,tired from ER for palpitations, sob, nausea, C/P.
Hx: afib, HTN, no hx of DM.
Labs: K+ 5.4, no other abnormal labs
Meds given in ED:
It was end of shift and my CN was already gone and the RN I asked for clarification with had no idea at the seeming counter productive med treatment. I go back tomorrow but was hoping someone could give me some clues. I'm not sure what I'm missing and of courses I feel like an idiot not beginning to see the sense of this.
Thanks for your time.
- 0Apr 12, '13 by Rhody34I'm also a new nurse working on a tele floor. I've seen this ordered many times for hyperkalemia. Insulin moves potassium back into the cells- in turn, lowering the serum potassium level- giving the kidneys time to excrete the potassium in the urine. The D50 is to prevent hypoglycemia (I think any way). Like I said- I've seen this ordered many times, it's pretty effective- however, I think the kayexalate seems to work better.... in my opinion any way.
- 0Apr 13, '13 by turnforthenurseRNAs for the calcium chloride, it helps "protect" the heart. The extracellular potassium is shifting into the cells thanks to the insulin, so this can potentially cause dysrhythmias.
Typically, calcium gluconate is used in this "cocktail," as it is less irritating. Calcium gluconate contains 9mg/mL of calcium (10% solution) whereas calcium chloride contains 27mg/mL (10% solution).
Also keep in mind that the insulin/D50/calcium gluconate combo is only temporary. Potassium will begin to leak back out of the cells after awhile. Therefore, the only definitive way to get rid of potassium is with Lasix, kayexalate or dialysis.
- 0Oct 22, '13 by turnforthenurseRNQuote from momRNmyI have also given albuterol to help lower K+, though this isn't as popular as the other hyperkalemia cocktail.Just a side note: in addition to the meds listed above, I've also given albuterol nebs to help lower a K > 7. The drop alone isn't drastic, but helps to treat hyperkalemia emergently in combination with the other meds.