Dealing with high K+ levels

Nurses Medications

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hi everyone,

i have been told by our nurse unit manager from accident and emergency that when a patient is admitted with high k+ (potassium) levels, then we administer:

  1. ventolin
  2. insulin and glucose
  3. resonium

can anyone explain the reason why these three things actually lower the potassium level? and how?

i would really appreciate any help, and thanks in advance for your responses !

kind regards,

david

Specializes in ER, IICU, PCU, PACU, EMS.

When a patient has hyperkalemia, the medical management has several aspects.

~ Protect the heart from toxicity - IV Calcium

~ Prevent any more potassium intake: diet, medications

~ Increase re uptake of potassium by the cells to lower serum K+

+ Ventolin is a beta 2 adrenergic agonist that increases the sodium/potassium/ATPase pump which moves

extracellular K+ into the cells and lowers serum potassium.

+ Insulin moves glucose into cells, but it also makes cells more permeable to certain electrolytes such as K+, Mg+

and phosphate. So insulin will lower serum potassium, but it will also lower glucose levels which is why you need to

give glucose to prevent hypoglycemia.

~ Promote excretion of potassium from the body

+ Calcium resonium contains sodium and performs an ion exchange. It binds with the potassium in the GI system,

prevents potassium from entering the bloodstream and is excreted in feces.

Specializes in Med Surg, ER, OR.

i remember the insulin/glucose IV, but didn't realize you could use Ventolin or resonium for that too. I work closely with CRF/ARF pts so we also use emergent dialysis if needed

  1. Beta2-adrenergic agonist agents promote cellular reuptake of potassium, possibly via the cyclic gAMP receptor cascade.
  2. Stimulates cellular uptake of K+ within 20-30 min; administer glucose along with insulin to prevent hypoglycemia (monitor blood glucose levels closely).
  3. Calcium polystyrene sulfonate is a cation exchange resin prepared in the calcium phase. Each gram of resin has a theoretical in vitro exchange capacity of about 1.3 to 2 mmol of potassium. As the resin passes through the colon, it comes into contact with fluids containing increasing amounts of potassium

If you want specifi biochemical pathways... see for yourself.

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