[TMEEKEE]

I WOULD SAY B. BECAUSE POTASSIUM CAN AFFECT CARDIAC RYTHUMS.

[EastCoast]

Originally posted by purplemania
Ability to void is my guess, because as pedi nurse our policy was never start the KCL until the kid could pee on his own. Even being cathed in ER did not count.

As ToddSPN points out why would you hydrate and then replete electrolytes afterwards?? Do both at the same time.

Hydrating agressively without repleting other electrolytes puts you in the position of causing a dilutional hyponatremia or water intoxication and you are further up the river. why in the world would you wait till the kid can pee when he is hypokalemic. You could be hours and and he could die. Put a foley in him and give him the K. Tomorrow when he is hydrated and repleted pull the foley and see if he can pee.

[jnette]

I'm sticking to my story... C. Ability to void. I'm saying this on the simple question as stated in the original post... without reading all sorts of other variables into it.
Reading just the question and given options, I still go with C.

Would be interested to hear the correct answer when you get it !
Always willing to learn !

[Brownms46]

I don't think the question is so much of waiting him to actually void. My impression is that this question might be asking about renal function. So yes you could put a foley in, but should wait until there is some urine ouput first. I maybe reading into this question, but my guess is C

[cannoli]

Okay, so what's the answer?

[Love-A-Nurse]

Since KCL is excreted by the kidney, C is the answer, because if there is not an indication of urine output, KCL excess can lead to major problem [cardiac] if not excreted and it should be administered slowly.

[Todd SPN]

I dunno. I don't see where renal function plays into this. If there was a renal disease I would think they would have to be very careful with administering K+. And as stated in the question, an IV is running so they must be trying to rehydrate meaning there would be a lack of voiding at this point. They also state pt has gastroenteritis, not renal impairment. Hyperkalemia would lead to arrhythmia that would show in an ECG. I gotta stick with B.

[uk_nurse]

Can nurse add KCL to an IVI? here in uk we are not allowed to add things like that to IVI's. our fluids come already done with them added. e.g the fluids we use have added potassium of 10 or 20 mmols. Apparently there has been mistakes made by nurses up and down the country when other drugs were added so it was made that no nurses can add anything to a bag of fluid. Sorry if i have ventured off the question but i was surprised you can add things to your IVI's.

[Brownms46]

Originally posted by Todd SPN
I dunno. I don't see where renal function plays into this. If there was a renal disease I would think they would have to be very careful with administering K+. And as stated in the question, an IV is running so they must be trying to rehydrate meaning there would be a lack of voiding at this point. They also state pt has gastroenteritis, not renal impairment. Hyperkalemia would lead to arrhythmia that would show in an ECG. I gotta stick with B.

First when hydrating a pt., renal function always comes into the situation. Yes rehydration is done in gastroenteritis, d/t diarrhea, especially per IV when vomiting. But that doesn't mean you don't have to assess whether or not kidneys are normal, and GI fld losses can lead to acute renal failure.

Second I thnk you meant to write hypokalemia, and yes both can cause ECG changes, but this is not a priority in accessing this pt. prior to giving K+ , but renal function is IMO.

[jenac]

I would have to agree with B as the best answer here, due to the potential cardiac implications.

Correct me if I'm wrong guys- but the hydration/electrolye imbablances are implied, hence the IV to begin with. If the child is already dehydrated-the output may be minimal to start with anyway, atleast initally. I'm alittle out of sorts with Gastroenteritis-but I would probably expect to see HYPER-active bowel sounds and diarrhea, so the independant bowel movements and active BOSO wouldn't be of primary concern. Right?

Interesting discussion though..........