[Love-A-Nurse]

Originally posted by jenac
Thank you Love-A-Nurse. My sediments exactly. My concerns here was that potassium might CAUSE an arryhtmia or other cardiac problem. If there is already an irregularity, I would be very careful admisinstering it-and atleast know to monitor it.

[EastCoast]

The ability to void independently is not a solitary indication that the kidneys are working. If the child pees 8 cc by himself of brown sludgey urine I would be worried. If he has a bladder full of urine and for whatever reason can't find the gusto to pee I would not hesitate to give the K. There are a lot of peolple with creatnines that are elevated who void independently. The fact of the matter is is that if the K is low you need to replete it. Sitting around trying to lower a creatnine while you patient develops more severe electrolyte disturbance is sillly. It is much easier to put someone on dialysis or give some Kayexylate and insulin that it is to defibrillate them because they are severely hypokalemic and acidiotic.

[Brownms46]

I think there is some confusion here with monitoring a pt. receiving K+ and getting a baseline ECG. Yes I would monitor a child getting K+, but I wouldn't get a baseline ECG before adding the K+ to an IV. I mean what is the baseline ECG going to show you, except that the K+ is low, which you would have already been confirmed prior to an order of K+?

[Brownms46]

Originally posted by Love-A-Nurse
Brownie, thanks for the clarification.

You're welcome Love-A-Nurse.

[cannoli]

Okay, so where is the person that posted this question and what is the correct answer?

Probably it was a question on a test and the original poster didn't know the answer (and probably still doesn't).

[EastCoast]

from
http://www.emedicine.com/ped/topic1121.htm



The ECG in hypokalemia may appear normal or may have only subtle findings immediately before clinically significant dysrhytmias.

Ventricular dysrhythmia

Prolongation of QT interval

ST-segment depression

T-wave flattening

Appearance of U waves

During therapy, monitor for changes associated with overcorrection and hyperkalemia, including a prolonged QRS, peaked T waves, bradyarrhythmia, sinus node dysfunction, and asystole.

Cardiovascular examination findings may also be within normal limits. Occasionally, tachycardia with irregular beats may be heard. Severe hypokalemia may manifest as bradycardia with cardiovascular collapse.

I guess what the article is stating is having a baseline gives you the ability to compare if the patient develops complications from over correction. That's my interpretation. I understand about assessing the ability to void as i said but i think that is different from assessing renal status.

If it was my kid i think i would like a baseline EKG after reading this article.

Wise RN where are you.??

[gwenith]

The real division in thinking here is between adult and paediatric. East coast I would venture to guess you are an adult nurse and have not worked paeds???

I have not done a lot of paeds but it is my experience that they are far less likely than adults to do ECG's (12 lead that is) and that a child will void when the bladder is full. You try not to cath children if you can help it.

Oh and I have to disagree on the bradycardia. Not all patients with hyperkalaemia develop bradycardia especially if it is associated with end stage renal failure. This BB has the merck manual online.

[Kayde]

I work in a peds unit. We do not add K unless the child has voided a decent amount.

[EastCoast]

mea culpa....

just called our peds unit and they too also check to make sure kids pee before first before giving KCL.

no, they don't always do an EKG (it depends)

Sometimes they monitor continuously if K is low and it is warranted.

Thank you for the enlightenment and for teaching me something.
Took me 2 days and 4 posts but i learned something today.


and gwenith, yes adult critical care.

[Brownms46]

Hey EastCoast, thanks for searching out the answer. And you know what??? If I need critical care, I want to have you or a nurse like you taking care of me!