IV potassium - page 2

I have a question regarding the administration of IV potassium. I recently graduated from nursing school, so I am always trying to learn and I ask a lot of questions. I received an order from doctor... Read More

  1. by   Tenesma
    one thing to remember is that it is a lot faster to replete K+ PO than it is to replete it IV....
  2. by   begalli
    Not if the patient's gut isn't working well. IV K+ always works immediately, while PO K+ takes at least 30 minutes to begin to take affect with a person with a healthy gut.
  3. by   Tenesma
    define "gut isn't working well"...

    potassium is primarily absorbed in the stomach and its absorption rate is near 100%... so even if you have poor intestinal function, it will still work fine...

    and you can give larger doses of Potassium PO (ie: 40 mEq) then you can give IV (ie: 10-20 mEq) on the floor...

    so your 10-20mEq IV over one hour is way behind your 40 mEq straight into the stomach!

    by the way, hypokalemia rarely if ever kills people - so I don't understand this rush to replete potassium so quickly anyway (unless they have prolonged QT syndrome or some other genetic risk predisposing them to QT prolong/Torsades or they are on other drugs that require normal/higher K levels).
  4. by   ladylynx
    Quote from Angie O'Plasty, RN
    PS No matter what the MD prescribed, you'll be held to the nursing standard of care, so follow hospital policy. If the MD prescribes something that hospital policy does not allow, it's your job to call him and inform him and get the order changed. If he won't change it, go up your chain of command and get your supervisor to talk to him. I usually try to give my Charge nurse or supervisor a heads-up in these situations just so they'll be prepared with the situation should the need arise to talk to the MD themselves.


    Also, here's the link from Davis's Nursing Drug Guide. Your drug guide should be the first place to look and there should be at least one on every unit.

    http://www.drugguide.com/monograph_l...phosphates.htm
    I am glad to see so many nurses with such knowledge. I have wondered for a while where they were until I joined this site. Definitely, we must realize "policy" is the law in most cases of accountability. These policies often come with years of study and statistics. This is the only way to hold the physicians more accountable. My first deposition last year (and it was only the pre-deposition), has reinforced my knowledge, determination, and belief, that physicians must be held accountable in giving us wrong orders. I have been an LPN for 15 years and I am on mission for my patients. Peace and love...nothing less! Cathy
  5. by   ladylynx
    Quote from barefootlady
    Never run K+ without a pump. I would be very scared of this instructor. Sure there are ICU situations but on the floor no way.
    Unfortunately, even here in the United States of America, there are hospitals that do not supply IV pumps on the Med/Surg floors. But otherwise, this would be true.
  6. by   Tenesma
    ladylynx... i am glad you are on a mission for your patients.... I am sure the doctors are on a mission to do as much harm as possible with their minimal knowledge!!!
  7. by   ladylynx
    Quote from Tenesma
    define "gut isn't working well"...

    potassium is primarily absorbed in the stomach and its absorption rate is near 100%... so even if you have poor intestinal function, it will still work fine...

    and you can give larger doses of Potassium PO (ie: 40 mEq) then you can give IV (ie: 10-20 mEq) on the floor...

    so your 10-20mEq IV over one hour is way behind your 40 mEq straight into the stomach!

    by the way, hypokalemia rarely if ever kills people - so I don't understand this rush to replete potassium so quickly anyway (unless they have prolonged QT syndrome or some other genetic risk predisposing them to QT prolong/Torsades or they are on other drugs that require normal/higher K levels).
    All the hospitals I have worked recently have what they call "Potassium protocols". So they say low potassium needs to be addressed very quickly because it promotes healing/quicker recovery. Patients who present with gastric problem i.e. vomiting, diarrhea (especially CDT), ileus, and gastroparesis often have problems with dehydration, muscle aches and abnormal EKG's. This all can and has lead to death. Potassium is only one of the electrolytes addressed. But lab values often show that IV administration works immediately and the results of po are often not seen until the next day. At some of the hospitals, my colleagues and I have noticed that we give so much po potassium according to policy (sometimes exceeding the maximum daily dosage), that they become hyperkalemic >5.0 by the next day. For some reason checking the labs less than 12 hours after po administration, does not show much of an increase in the values.
  8. by   Tenesma
    ladylynx... what you are saying is not based in fact.

    1) due to its high bioavailability and rapid absorption, enteral potassium provides adequate potassium replacement in a patient that can tolerate PO.

    2) there is no evidence linking potassium replacement with "quicker" healing and "quicker" recovery...

    3) dehydration can lead to death... abnormal EKGs can lead to death... hypokalemia can be seen in chronic dehydration... however, that doesn't mean that the hypokalemia caused the death

    4) Potassium is an intrinsically INTRA-cellular ION, and therefore any potassium you give will first shift intra-cellularly before you start noticing differences in Plasma levels... therefore, combined with point #1, your lab values will always be delayed in showing a response, and whether it is PO or IV the lab values will respond IDENTICALLY in the same patient if the PO and the IV milli-equivalent dose is the same.

    5) a patient with functioning kidneys CAN be given extra potassium without a problem because they will excrete excess potassium... and therefore, you will not see patients have a K>5.0 after Potassium supplementation unless they are in renal failure -

    in fact, if i made you take PO or IV potassium for 24 hours, and we measured your Potassium, i bet your potassium will barely change as you will void most of it....

    back to your previous post about policies... They are not based on years of studies and statistics, they are based primarily on a consensus committe of nurses and physicians for generalized circumstances/situations. They are not applicable to everything and many times, they are wrong in certain situations.... and thank god, physicians can (and do) override them when the patients best interest is at stake.... and no, nursing policies don't hold physicians accountable, they are there for the nurses.
  9. by   ladylynx
    Quote from Tenesma
    ladylynx... what you are saying is not based in fact.

    1) due to its high bioavailability and rapid absorption, enteral potassium provides adequate potassium replacement in a patient that can tolerate PO.

    2) there is no evidence linking potassium replacement with "quicker" healing and "quicker" recovery...

    3) dehydration can lead to death... abnormal EKGs can lead to death... hypokalemia can be seen in chronic dehydration... however, that doesn't mean that the hypokalemia caused the death

    4) Potassium is an intrinsically INTRA-cellular ION, and therefore any potassium you give will first shift intra-cellularly before you start noticing differences in Plasma levels... therefore, combined with point #1, your lab values will always be delayed in showing a response, and whether it is PO or IV the lab values will respond IDENTICALLY in the same patient if the PO and the IV milli-equivalent dose is the same.

    5) a patient with functioning kidneys CAN be given extra potassium without a problem because they will excrete excess potassium... and therefore, you will not see patients have a K>5.0 after Potassium supplementation unless they are in renal failure -

    in fact, if i made you take PO or IV potassium for 24 hours, and we measured your Potassium, i bet your potassium will barely change as you will void most of it....

    back to your previous post about policies... They are not based on years of studies and statistics, they are based primarily on a consensus committe of nurses and physicians for generalized circumstances/situations. They are not applicable to everything and many times, they are wrong in certain situations.... and thank god, physicians can (and do) override them when the patients best interest is at stake.... and no, nursing policies don't hold physicians accountable, they are there for the nurses.
    Out of respect for all...I would never give info that was not based on fact. But this challenge is refreshing I must admit. Because I worked through agencies over the past 15 years, I got to see how others did things and I had to know certain policies to justify my actions and license. As I mentioned in another discussion, my deposition woke me up. Policy was the only thing the attorney talked about. On a med/surg floor, he was not concerned about the reasons that a doctor gave. By the way, the patient died, and thank God for the backing of my charge nurse and the ICU nurses that followed, many changes took place in that hospital with the physicians.

    The lab values are discussed because every night each of us had at least 1 patient out of 7, that had to get potassium replacement. That is the only thing I can go by. As a matter of fact when I left the state of Florida, they were discussing making some changes regarding there protocol.

    As for hypokalemia and death...I can only go with the facts. Take a look at the link and I have found many more. http://www.hmc.psu.edu/healthinfo/h/hypokalemia.htm

    I hope you are not a doctor, but for those of us nurses who get hung up, given wrong dosages, no return calls, etc (especially at night)...we only have policies to back us up. If we do not acknowledge them and go with the doctor only, we would lose our license and job. "The doctor said so", is no longer acceptable.

    By the way, "chronic" and "acute", it doesn't matter with renal failure. I had an 18 year old come in with N/V/D, never been sick before, came in with that dx and acute renal failure...all electrolytes were out of wack. The patient was rushed 2 days later to a larger hospital only to be told they would die in a few days for complete shutdown (and she did). This was from shell fish. So acute vs. chronic...I could go on and on regarding the kinds of patients that we saw.
  10. by   Tenesma
    i am sure you have seen a lot of patients... the 18 year old i would suggest did not die from hypokalemia...

    my point, originally, is that there is rarely the need for aggressive potassium repletion.... in the literature there is no proven link between hypokalemia and death other than case reports, except for in the setting of Acute Coronary Syndrome (ACS) - and that is why it has been extrapolated to all cardiac patients to aim for a normal K+ level.

    as far as literature goes, i would stick with the literature (instead of a website)... my recommendation would be: N Engl J Med 1998; 339:451-458, Aug 13, 1998... a great review article on hypokalemia by John Gennari (a great nephrologist).

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