[mittels]

Originally posted by Tenesma
mittels what is your point about the K??? and what does that have to do with liver failure?

Critical thinking now!!!!
K+ and glucose in LR where does K+ metabolize?

Metabolic acidosis with compensation

[athomas91]

i am fully aware of what substances LR consists of.....my point is if there are better fluids out there to use, why would LR be used in that scenario....

and.... in an acidotic state - the K+ will be more attracted to the negative vibe extracellularly thereby moving out of the intracellular space - causing a false elevation of K+ (such as happens in DKA) - so why in the world would you give an infusion of RL which could exacerbate this "false" hyperkalemia??

[Tenesma]

mittels....

1) there is no glucose in LR
2) there are 4mEq of K per liter of LR
3) potassium does not get metabolized --- what would the breakdown product be???
4) what does administering potassium have to do with metabolic acidosis???

if the patient is acidotic the patient will have a falsely elevated potassium due to the extracellular shift of potassium - so let's say the patient has a K=6.5 due the acid/base imbalance, can you please explain to me how diluting their blood with one liter of fluid containing 4 mEq of potassium is going to raise their potassium??? that doesn't make sense, if anything it would dilute their potassium.... the only time i wouldn't administer LR to a patient who is hyperkalemic is when they are in acute renal failure and are unable to excrete excess potassium... however in patients who are in hepatic failure and who have renal failure (usually due to a hepato-renal syndrom), they should be on dialysis, and when a patient is on dialysis it doesn't matter what kind of fluid you administer, since the excess K is leeched off in the dialysis bath.

the only times i would not administer LR due to the concern regarding potassium content: hyperkalemia due to TRUE excess of potassium, not simply potassium shifting in or out of cells due to acid/base status.

this time i won't make a big fuss about you telling me: "critical thinking now!!!" - next time i won't be so kind

[mittels]

Originally posted by Tenesma
mittels....

1) there is no glucose in LR
2) there are 4mEq of K per liter of LR
3) potassium does not get metabolized --- what would the breakdown product be???
4) what does administering potassium have to do with metabolic acidosis???

if the patient is acidotic the patient will have a falsely elevated potassium due to the extracellular shift of potassium - so let's say the patient has a K=6.5 due the acid/base imbalance, can you please explain to me how diluting their blood with one liter of fluid containing 4 mEq of potassium is going to raise their potassium??? that doesn't make sense, if anything it would dilute their potassium.... the only time i wouldn't administer LR to a patient who is hyperkalemic is when they are in acute renal failure and are unable to excrete excess potassium... however in patients who are in hepatic failure and who have renal failure (usually due to a hepato-renal syndrom), they should be on dialysis, and when a patient is on dialysis it doesn't matter what kind of fluid you administer, since the excess K is leeched off in the dialysis bath.

the only times i would not administer LR due to the concern regarding potassium content: hyperkalemia due to TRUE excess of potassium, not simply potassium shifting in or out of cells due to acid/base status.

this time i won't make a big fuss about you telling me: "critical thinking now!!!" - next time i won't be so kind

Good job with critical thinking. I am not saying to give a pt with liver failure LR. Also think about this, with live failure goes kidney failure. What happens when the kidneys cant dispose of K+. Metabolic acidosis and K+ you ask what it has to do with it. Think about it.

[javajunkie]

Wow! Dare I ask a question about something more complex than IV fluids? Tenesma, do you teach? You should. Your answers are great.

[athomas91]

Tenesma has an outstanding amount of knowledge....i really enjoy the posts.

[CRHSrn]

Tenesma,

thank you for clearing that up for me. what you have said really makes more sense. if my memory serves me right, you're an MDA, right ?

to everyone else,

thank you for your posts as well. i didn't mean to get everyone's feathers all ruffled .

[gotosleep]

Originally posted by mittels
Good job with critical thinking. I am not saying to give a pt with liver failure LR. Also think about this, with live failure goes kidney failure. What happens when the kidneys cant dispose of K+. Metabolic acidosis and K+ you ask what it has to do with it. Think about it.

did you bother to read tenesma's post?

[athomas91]

[Brenna's Dad]

I read a blurb the other day (have NOT done my Neuro didactic yet), that Plasmalyte and LR can be converted to glucose and thus are not the fluids of choice for Neuro pts.

Any comments??