Recently, in our unit, there have been a few patients whose potassium is 5.3 and the physician continues to want them on 3K bath. The potassiums are done weekly. Although, routine orders say decrease to 2K, I am wondering if other units function as this one. It would seem that if a patient's K+ level was lower it would be easier to 'fix' then having it too high.. I know that some units allow the nurses to change to bath, write a v.o. according to routine orders but this is perplexing. Why would a physician continue with a 3K when the patient's K+ is above 5.0 and not lower to 2K.? When asked he just says statements i.e. if there is not a problem, we don't fix it.. meaning the patient has had no symptoms, etc.
Also, nausea post dialysis and 'only' post dialysis, no other time indicates what? My training says could be dry weight needs to be adjusted, too much fluid removal..etc? What else? Thx
A doc once told me his rule of thumb:The K bath and serum K should add up to 6 to 6.5.
Serum K=5, Kbath=1. Serum K=4, Kbath=2. Its a rough estimation, but works well on the fly.
Last edit by mo-mo on Mar 29, '07
: Reason: Punctuat!on
There are some doctors that still prescribe a 0 K bath for some patients. I think it's dangerous and unnecessary and just plain stupid. The highest serum potassium level I've seen was 8.6. Dialyzed her with 2K and brought the post down to 4.2. (Urr would have looked great) Of course the condition of the access along with the blood and dialysis flow rates has lots to do with it. I'm in the hospital doing acutes. so obviously there is much closer monitoring.
Dehydration does not effect the serum potassium level. And, by the way, there should be a fairly good BUN, like above 30 or more. Low Bun indicates lack of nourishment, especially protein. Low Albumin hinders the fluid from shifting into the blood where it can be removed. Morbidity rate is higher in patients that don't have much intake of protein or fluid.
Last edit by diabo on Apr 1, '07