Iv mag or k+ which do I hang first? | allnurses

Iv mag or k+ which do I hang first?

  1. 0 Recently I had a patient that needed both iv k and iv mag. The patient had one patent iv site. I hung the potassium 1 st because it would take the less time. Then get the mag started. When handing off my patient the rN told me that the mag should go first because it is what the k will stick to. I had not heard this before and am unable to find any information on this. Has anyone else?
  2. Visit  JenniferG rN profile page

    About JenniferG rN

    JenniferG rN has '8' year(s) of experience. Joined Nov '13; Posts: 16; Likes: 13.

    33 Comments so far...

  3. Visit  Anna Flaxis profile page
    3
    Well, while I'm not sure I agree with the other RN's verbiage, she is correct that hypomagnesemia can make hypokalemia refractory to treatment, so hanging the mag first would be the correct action, as far as I know.

    Just out of curiosity, what order did the MD write for them in?
    AJJKRN, SoldierNurse22, and Esme12 like this.
  4. Visit  flyingchange profile page
    3
    According to Lexicomp, these are compatible, and there are no warnings against infusing concomitantly - is there any reason you couldn't run them together?
  5. Visit  Anna Flaxis profile page
    1
    I wondered that too, but it's pretty common practice to run things in one at a time on stable patients because if they have an adverse reaction, you can be pretty certain which medication they're reacting to. Also, in this case, I'd want to correct the hypomagnesemia prior to administering the K+, since as I mentioned above, the low K+ may be refractory to treatment in the presence of hypomagnesemia.

    But, I'd be curious to hear the OP's rationale as well.
    Esme12 likes this.
  6. Visit  MunoRN profile page
    3
    Ideally, you give mag first, although it's not critical to do so. Magnesium modulates the transport of potassium into cells. Low magnesium = decreased potassium uptake which results in more of the potassium you gave being excreted.
    PCTerrific, AJJKRN, and Esme12 like this.
  7. Visit  Anna Flaxis profile page
    2
    Mmmm, sort of...intracellular Mg2+ modulates the transport of K+ *OUT* of cells by blocking secretion of K+, so if there is a deficiency of intracellular Mg2+, then more K+ is secreted by the distal renal tubule. Only about 2% of the total Mg2+ in the body is in the plasma. The rest is in bones and cells. It takes 3-4 hours for the Mg2+ in kidney and heart cells to exchange with the Mg2+ in plasma, meaning that you should give the mag first so it has time to start moving into the cells so that it is more likely to be effective in blocking potassium excretion.
    Last edit by Anna Flaxis on Nov 18, '13
    JustaGypsy and AJJKRN like this.
  8. Visit  Larry77 profile page
    7
    Isn't this an ED Nursing thread? Start another line and run them both if you are worried about running them together. Save me from this ICU'ish intracellular speak :-)
  9. Visit  MunoRN profile page
    1
    Quote from ~*Stargazer*~
    Mmmm, sort of...intracellular Mg2+ modulates the transport of K+ *OUT* of cells by blocking secretion of K+, so if there is a deficiency of intracellular Mg2+, then more K+ is secreted by the distal renal tubule. Only about 2% of the total Mg2+ in the body is in the plasma. The rest is in bones and cells. It takes 3-4 hours for the Mg2+ in kidney and heart cells to exchange with the Mg2+ in plasma, meaning that you should give the mag first so it has time to start moving into the cells so that it is more likely to be effective in blocking potassium excretion.
    We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net uptake to improve potassium levels, it's sort of like cells are scooping up potassium with a bowl, except those with low magnesium are scooping them up with a colander. Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion.
    cricket67 likes this.
  10. Visit  Anna Flaxis profile page
    0
    Quote from MunoRN
    We don't infuse potassium into the cells, we infuse it into the serum and then depend on good net uptake to improve potassium levels, it's sort of like cells are scooping up potassium with a bowl, except those with low magnesium are scooping them up with a colander. Cells with low potassium are leaking the potassium they are receiving right back out, which decreases the net uptake and secretion.
    There is no inhibition of potassium uptake. Potassium is flowing into the cells just fine. The problem is that magnesium blocks potassium secretion back OUT of the cell, and with low intracellular mag levels, potassium is allowed to freely exit the cell. So, potassium uptake is not affected, and secretion is increased.
    Last edit by Anna Flaxis on Nov 18, '13
  11. Visit  Anna Flaxis profile page
    6
    Quote from Larry77
    Isn't this an ED Nursing thread? Start another line and run them both if you are worried about running them together. Save me from this ICU'ish intracellular speak :-)
    An ED nurse can't have an understanding of fluid and electrolyte balance? Sheesh!
    Last edit by Anna Flaxis on Nov 18, '13
    psu_213, rangerlil, serenity1, and 3 others like this.
  12. Visit  AJJKRN profile page
    0
    To respond to Larry777

    I have never worked in a ED but why wouldn't you want to do it right for the patient the first time...fast isn't always the best...just like placing every IV start in the AC for a patient being admitted!!!

    I have tremendous respect for ED nurses but this comment just seems...frankly...not well thought out...maybe more time to think was needed!
    Last edit by AJJKRN on Nov 18, '13 : Reason: Realized the quote was absent ;-)
  13. Visit  JenniferG rN profile page
    1
    Quote from AJJKRN
    To respond to Larry777 I have never worked in a ED but why wouldn't you want to do it right for the patient the first time...fast isn't always the best...just like placing every IV start in the AC for a patient being admitted!!! I have tremendous respect for ED nurses but this comment just seems...frankly...not well thought out...maybe more time to think was needed!
    Thank you you for your response to that
    AJJKRN likes this.
  14. Visit  Larry77 profile page
    9
    I was merely being facetious. This is an interesting topic and I was pointing out that it is not a typical discussion that is had in ED's, but rather one that my ICU friends would spend time looking up.

    I'm wondering if those ACTUAL ED nurses were offended by my sense of humor, if so, I apologize to YOU. If you have never worked in the ED you may not understand the normal ED mindset...life is too short to be so serious!

    Cheers...
    Last edit by Larry77 on Nov 19, '13
    psu_213, canoehead, That Guy, and 6 others like this.


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