A little experience please...

[MissERN]

Hi Everyone! I was hoping that those of you with more experience than myself could help me with a question. I'm a new grad in the ED and I've learned to ask questions frequently...smile!! On my days off I try to think back through patient situations that I didn't totally understand (there seem to be plenty of them) and try to read up on it so that next time I'll have more understanding of what's going on. So, here's my question for today...

Background: Yesterday had a dialysis patient present with weakness. Heartrate was 28 (I'd probably be weak too). Turns out his potassium was 6.8. I gave him 1 amp D50 IVP, 8 units regular insulin IVP, 1 amp sodium bicarb IVP, and got him to dialysis stat.

I understand that the insulin was to get some of the K from the ECF into the cells and that the D50 was given to prevent hypoglycemia. What I'm having a hard time wrapping my mind around is the rationale for the sodium bicarb. (the rationale is probably pretty obvious, isn't it) I know it's to reverse acidosis. I wish I would have had a chance to look at his labs longer, but I was rushing to get him to dialysis. I think I'll be trying to brush up on my acidosis/alkalosis knowledge in the next few days.

Y'all are the best...thanks in advance for any information you may be able to share. By the way, I love my job and spend way too much time on allnurses! :redbeathe

[Tait, MSN, RN]

According to this site:

http://www.nlm.nih.gov/medlineplus/ency/article/001179.htm

It helps reduce K levels by reversing acidosis.

More info (because I was wondering this myself and wanted more details!)

http://www.medhelp.org/Medical-Dictionary/Terms/1/001179.htm

Intravenous glucose and insulin moves potassium from the extracellular fluids back into the cells. This may reverse severe symptoms long enough to allow correction of the cause of the hyperkalemia.

Sodium bicarbonate causes potassium to shift from extracellular to intracellular fluids. It may reverse hyperkalemia caused by acidosis with no other treatment required. Prolonged use of sodium bicarbonate should be avoided because it may cause severe complications.

Taitter

[devi, ADN, BSN]

Very little experience here since I'm still a student, but thought I'd give it a go.

One of the ways the kidneys help control acid-base balance is by forming and reabsorption of bicarb. In kidney failure, they don't do too great a job of that (among other things), leading to the metabolic acidosis and the subsequent hyperkalemia (potassium being pushed out of the cells to neutralize intracellular acidity due to the extra H+ ions).

So, I figure the bicarb was administered to replace the bicarb the kidneys are not forming and not reabsorbing.

Maybe another poster with more experience can confirm or correct me here. I'm curious, too.

I'm also guessing that once the bicarb helps the extracellular pH balance, the extra H+ will leave the cells and the potassium should start reentering, lowering the serum potassium further.

[Jolie, BSN]

You might want to PM traumasRus with this question. It's right up her alley.

[MissERN]

Thanks for all the information! Great website Tait with lots of info. That's exactly what I was looking for with the sodium bicarb...that it causes the K to shift back into the ICF. And Devi thanks for your help! What you said makes perfect sense...someone who's kidneys aren't working well won't make the bicarb, therefore they become acidotic and then hyperkalemic. I certainly appreciate the help! And I took your advice Jolie! I hope you all have a wonderful day!