potassium level and fluid replacement

Dinith88 · Sep 18, 2009

Quick electrolyte question, would fluid replacement with NS in a slightly dehydrated pt lower pt potassium level?

By reading this, the assumption is that because patient was 'slightly dehydrated', you didnt rapidly and/or massively bolus her.

So...Quick answer: no..at least in that NS typically wont cause hypokalemia. (you may notice a drop/fluctuation but it's not usually significant)

But...if patient is dehydrated/pre-renal to the point that her creatinine and potassium are elevating (which, btw, would not be considered 'slightly dehydrated'), a fluid bolus many times will help to 'open-up' her kidneys and as a consequence could drop her potassium...(usually not to the point that she's hypokalemic)

TakeBack · Sep 19, 2009

Agree, there are transcellular shifts that occur w/ changes in extracellular fluid status that will cause K levels to vary, but with normal renal function the serum level should hover in the same range.

Coexisting issues- diuretics, acidosis, can cause more pronounced K swings.

Electrolytes don't typically hemodilute the way the hct does w/ volume infusion.

meandragonbrett · Sep 20, 2009

For the most part. Na is the electrolyte you might see the most with changes and fluid status. K moves into and out of the cell as needed to maintain homeostasis.

Manurse715 · Oct 1, 2009

Quick electrolyte question, would fluid replacement with NS in a slightly dehydrated pt lower pt potassium level?

dittos on the previous. If the K is high R2 dehydration Crt and BUN are up too then you very well could see your K come down as your kidney kick it up a notch. But no, isn't directly effected by dilutional situations like Na Alb or H&H are.

silver1 · Oct 31, 2009

I agree with all from above, If you do have somone that is extremely dehydrated, BUN will be elevated, Crit shouldnt be affected too much (its more of an indicator of function).

I have seen patients that were very dehydrated get 40mEq of K, and their potassium go from 3.7 to 6.1 (yes it was double verified with a peripheral stick) then get fluid and it came back down to 4.7, That pt's nurse was fairly new and was ready to give D50/insulin after the verification of the 6.1. Pt's CVP was 2.