High K...when to check bg's?

shadowflightnurse · Mar 19, 2006

Usually hourly is reasonable. Typically DKA's who get insulin bolus/drip will get an hourly BG check. Unless the patient was showing signs of being hypoglycemic, I wouldn't worry. Would be good to know his BG before the boluses though, just to make sure you are in a safe range to give the insulin. The D50 is to keep the BG from getting to low following the insulin bolus, but if the BG was 60 and you gave the insulin/D50, etc, you would need more frequent checks, or to lower the insulin bolus (depending on the doc).

tridil2000, MSN, RN · Mar 19, 2006

I had a "train wreck" pt last night. 74yo guy with ileostomy/colostomy/feeding tube/no void/abd pain/vomiting/came from nursing home with his wife who was in the process of a lawsuit with the surgeon who did all his abd surgeries...
I got a line in him, drew labs and gave him zofran and dilaudid. labs came back with a K+ of 6.9. Doc orders sodium bicarb, 10u reg insulin, d50, and lasix. I checked his bg about 20 minutes after all of this was given. We were shipping him to a hospital with dialysis. it was also shift change. I was trying to finish all his paper work, call report and give report to the on-coming nurse. I checked his bg at 1900. he was 237. I shipped him at 1945. I had not re-checked a bg...I've been stressing all night. How often do you check a bg after giving those medications?
:selfbonk: I am a fairly new grad/new ER nurse (1 year as new grad/8months as ER nurse) I had 4 other pt's and the ER was really jammed, so no one to help me with this guy. I need to know what other interventions I should have done and how often bg's should be checked with a pt like this. (I did manage to put a foley in him for I&O's.)

you're fine. within the hour was a good check! the insulin and dextrose are suppose to cancel each other out. the insulin pulls the k into the cells and out of the blood. the dextrose is given bc glucose will go too. bicarb is used less these days. sometimes, you'll give calcium iv and k-exylate po too for hyperkalemia.

sounds like the guy had pre renal failure from ongoing dehydration and focusing on him was clinically sound!

good job!

scrmblr · Mar 21, 2006

you're fine. within the hour was a good check! the insulin and dextrose are suppose to cancel each other out. the insulin pulls the k into the cells and out of the blood. the dextrose is given bc glucose will go too. bicarb is used less these days. sometimes, you'll give calcium iv and k-exylate po too for hyperkalemia.
sounds like the guy had pre renal failure from ongoing dehydration and focusing on him was clinically sound!
good job!

Thank you. really really thank you.

I have been feeling really inadequate and this pt was a tough one for me. I had an order for k-exalate, but the guy was unable to drink it and he had no bowel for the rectal route...So the doc cancelled the order.

Thanks again!