RX for K+ Chloride AND Na Chloride

  1. OK so I'm trying to think by KISS (keep it simple stupid)
    I ran across a vented patient the other day that has Sodium Chloride 10ml Q8h IV and Potassium Chloride 20MEQ qd NGT. Na was 141 and K was 4.7 I thought you would give one or the other for electrolyte imbalance...or maybe I am missing something????. Can someone please help me understand the reasoning? I'm a very new nurse and still learning!
    Thanks!
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  2. 12 Comments

  3. by   Wise Woman RN
    Perhaps the NaCl is for a central line flush, done Q8 hours to keep the line open... the KCl is probably a daily med, perhaps the patient is on Lasix or Bumex, and needs the supplement to keep levels normal?? And I would let the MD know about the levels if he doesn't come in and check them daily, or as he orders them...
    Last edit by Wise Woman RN on Nov 15, '07 : Reason: afterthought...
  4. by   ginger58
    Let's KIS! First, the Sodium Chloride would also be expressed in mEq as is the K. Not uncommon at all to treat all electrolytes--usually the Na & the Cl, and at times the K+. A lot of times the Na will reflect hydration of the patient. So if the pt is dry the Na and Cl will be higher. The K+ is a separate thing. K+ resides in the cell and depends on acid-base conditions. If cells are destroyed the K+ is released into the blood and the serum K+ level rises. That why you have to be careful handling a K+ sample so as not to destroy cells. The doc is choosing to give the NaCl IV and the KCl via NGT.
    Depending on the drugs the patient is on (ex. Lasix) or if he has GI losses the doc is trying to keep up with the K+. K+ is hard on veins so this is probably why he's giving it via tube.
    Some standard IV solutions will have both electrolytes in.
    This will come more readily to you as time goes on. Lytes are a very important lab for the nurse to know normal values and to notify the doc asap if the lytes are out of wack. Best.

    PS since I just read the post above mine, I realized that it really could be 10 ml to flush the line.
    Last edit by ginger58 on Nov 15, '07 : Reason: Add the PS
  5. by   discobunni
    Hmmmm. I do need a KISS! DUH If I paid more attention to the dosage for that part I would've known that.
    The pt was in respiratory alkalosis, I guess the reason for the K+. The pt gets dialysis (I guess instead of the diuretic) but they use 1000ml of NS for that 3 days/week...I guess I wasn't thinking either that that wouldn't have time to absorb, right? :smackingf
  6. by   ERRNTraveler
    10ml of Sodium Chloride (which is just normal saline) IV Q 8 hours would just be a routinely scheduled saline flush....
  7. by   rn undisclosed name
    Quote from discobunni
    Hmmmm. I do need a KISS! DUH If I paid more attention to the dosage for that part I would've known that.
    The pt was in respiratory alkalosis, I guess the reason for the K+. The pt gets dialysis (I guess instead of the diuretic) but they use 1000ml of NS for that 3 days/week...I guess I wasn't thinking either that that wouldn't have time to absorb, right? :smackingf
    The 1000 ml of NS is used for when they do dialysis. Can't do HD without it. In my facility I always have to provide 2 bags of NS for the dialysis RN/tech who is performing HD. The K is not necessarily for respiratory alkalosis. Some patients do require daily doses of K for various reasons. Most dialysis patients don't but others do. You just have to take it on a patient by patient basis.

    I'm a little confused about your statement regarding the patient getting dialysis instead of the diuretic. What do you mean by that?
  8. by   discobunni
    There isn't a diuretic prescribed. I was thinking that since they are pulling the fluid off with dialysis, a diuretic wasn't necessary. Is that wrong?
  9. by   Diary/Dairy
    Dialysis might be to help pull filter out toxins if the patient is still making urine but the BUN/Cr are high.

    Receiving Lasix or GI losses (ie NG suctioning or diarrhea) can lead to potassium losses.

    Just thinking out loud here.
  10. by   TiredMD
    Dialysis is pretty complex, which is why every other doc is pretty much happy to leave the field to nephrologists. I used to do nephrology research when I was in med school, so I thought I'd offer a couple of things I vaguely remember.

    - In general, yes, diuretics get discontinued when dialysis is started because (at least in theory) you ought to be able to pull off excess fluid with tid dialysis. There is a March 2007 paper in the American Journal of Kidney Disease that suggests continuing diuretics in dialysis may be associated with lower cardiac mortality and improved clinical markers, but I don't think that is standard of care right now.

    - Generally people retain potassium when on dialysis. I'm guessing most folks here who have worked on med/surg, ER, or ICU have had at least a few patients who missed dialysis and came in with K levels that were ridiculously high. I'm kind of suprised . . . no, actually shocked . . . that the patient in this thread was on potassium supplements.
  11. by   Virgo_RN
    What was the trend? Was the patient's K+ level rising, or decreasing?
  12. by   discobunni
    I'm not sure what the trend was, I only had the most recent labs available to review. I was wondering if this pt was being over-ventilated because the ABG's showed respiratory alkalosis...perhaps that was the reason for the K+ order?
  13. by   Virgo_RN
    I think the K+ order was more likely related to the patient's lack of PO intake (where we get our potassium) and NG suction (one way we lose potassium). 20mEq per day isn't a huge dose. If the patient is in respiratory alkalosis, I'd expect to see the vent rate decreased.
  14. by   Wile E Coyote
    Just because a pt is requiring HD, does not preclude them having urine output. Therefore, the loss of lytes via normal urine output is still a valid justification for the daily repletion.

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