Dealing with high K+ levels

[davidthenurse]

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

[Medic2RN, BSN, RN, EMT-P]

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.

[mcknis]

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

[Son Tava]

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.