Elevated K+--insulin?

[EJSRN]

Got a question. Had a pt today that had a really high K+ level on admission and they gave hime insulin, and dextrose in his iv fluids. Dont really understand this one. Anyone care to help? :) thanks!

[Blee O'Myacin, BSN, RN]

I wanted to add- the worst K I've seen was over 9!!! She was awake and alert, but her HR was in the 30's.

We gave insulin, D50, she was getting a neb treatment, got calcium (which I'm calling the resident and begging her to come put in a central line since I only had a 22g in the upper arm), and kayexalate. She might have gotten something else, I don't remember!

I'm surprised they didn't start dialysis ASAP on this patient - even if she was A&O. And figures that you had to beg for that central line, doesn't it.

[Harparia]

I heard in a lecture that it is like insulin has two arms. Both need to be filled to cross the cell membrane. One "arm" can carry glucose, and the other carries K+. So, insulin is usually given with dextrose to lower K+ levels.

Does that make sense?

Harparia

[blondy2061h, MSN, RN]

Worst K+ I saw was a 13 in a renal patient who tried to commit suicide by drinking OJ and eating bananas. She went to dialysis and survived unscathed.

[getoverit, BSN, RN, EMT-P]

Offhand, do you remember where you read about the bicarb?

My ER docs generally include bicarb in the hyperkalemia order. It's hit or miss with the kayexelate depending on who's doing the ordering.

Thanks.

I can't remember where it was, but if you google hyperkalemia treatment you'll get about 15K hits. I do remember it was an abstract written by a nephrologist and was within the past 3 months.

I used to give the bicarb all the time too, but not so much anymore unless they are in pretty profound metabolic acidosis. I had a patient last week who had a lot of compounding problems and that was the first time I'd given a bicarb bolus in awhile.

Sorry I'm not much more help than that.

[getoverit, BSN, RN, EMT-P]

Our nephrologist ordered 10mg albuterol (4 times the standard dose) for hyperkalemia recently. I had never heard of it, but she said it's a relatively new treatment.

The ER orders 10 units of regular insulin IV push, followed by an ampule of D50 or a D10 drip for critical K levels. Kayexalate treatment follows later.

yeah, 10mg albuterol is what I've given too and I hadn't heard of it until maybe 2-3 months ago.

[november17, ASN, RN]

It is a short-term fix for a potentially life-threatening problem. It gives the pt a little breathing space/time to excrete the K+

[talaxandra]

Unless the patient has diabetes we don't give insulin, just 25 - 50ml of 50% dextrose. The patient produces their own insulin in response to the sudden jump in circulating glucose, with a lower incidence of 'over-shooting' hypoglycaemia.

[Aneroo, LPN]

I'm surprised they didn't start dialysis ASAP on this patient - even if she was A&O. And figures that you had to beg for that central line doesn't it.[/quote']

We were waiting on the lovely, ever so prompt and pleasant MICU team to get their butts down there. LOL She did get dialysis as soon as they got the access and she got upstairs. The resident was in another part of the ER because they were busy- I don't think she understood the urgency of the situation, or how far I was willing to go above her head before I got what I wanted and what the patient needed.