Quote from nickieph
The other day during my peds rotation I had a 2 month old infant born prematurely. who was diagnosed with bacteremia and urosepsis. The original labs showed she had a slightly elevated potassium of 6.1 The 2nd draw showed the K+ at 4.1. The 3rd showed it at 5.6. The fluids hanging were D5w 10 mEq KCl ordered at 5cc/hrI asked the RN why the baby was receiving that when she had hx of elevated potassium and 3 RN's jumped down my throat, saying that there's barely any potassium in that and she's only getting 5cc/hr. I still don't understand why she would be getting that. True it's only 5cc/hr but she's only 3.405 kg and according to her labs her K+ is rising again.Can someone please help me with the rationale of this because I'm lost.
You might want to take a look at what happens to potassium levels during sepsis, specifically, what happens when the body becomes a little bit acidotic. There is a shift of potassium levels in the blood that occur during acidosis. It is entirely possible that this particular patient had a low potassium level overall, yet had a high serum potassium level because of the sepsis. The fluid maintenance level for this patient would be approximately 11 mL/HR, 5 mL per hour isn't even close to that. There has to be another reason why this patient was on D5W with 10 mEq/L at that rate.
I'm relatively new at this myself, I am still a student, just a bit farther along than you are. The only thing I can figure is that perhaps as they correct the acidosis, that would tend to drive potassium back into the cell, and may result in a hypokalemia, therefore they are providing some potassium to prevent that from occurring. If you are able to follow the case, it might be kind of interesting, see what ultimately happened, and perhaps all of us can learn from it!
Something that just struck my mind, is that it is entirely possible that the fluids that were ordered could be specifically to counteract a side–effect of some other medication that they also have ordered for patient.
Please, if you do figure out what the rationale was, please let me know, I really do want to learn for myself.