Potassium Level

  1. At what level do you call the doctor on a critical potassium? I had a doctor question me and order a stat ekg because I didn't call the doctor on a patients potassium that they replaced when it was on the high end of normal the previous day.
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    About Elyse545, BSN

    Joined: Feb '15; Posts: 23; Likes: 14
    ICU Stepdown/Cardio Med Surg Nurse
    Specialty: 1 year(s) of experience

    7 Comments

  3. by   ICU-BSN
    At my facility we call for anything that is a critical value. There is special documentation to complete for all critical values where you have to indicate which doctor was notified, at what time, and if any additional orders were received. Definitely report your critical values!
  4. by   chare
    At my facility, the nurse is notified by the lab of all critical values. The nurse is then required, by policy, to notify the physician of all critical values within 1 hour of receipt. The physician can also write an order to be specified of specific values, regardless of whether it was a critical value, or not. Again, the expectation is that the physician be notified within 1 hour

    I'm curious as to why the patient's potassium was replaced if it was high normal?
  5. by   NurseSpeedy
    Any critical lab result warrants a call, especially if it was on the high end of normal the day before. This shows a drastic change from the last result.

    Our facility has electrolyte protocol that many doctors will order on admission. Below 3.5 but above 3 give this, below three give this, if critical give this and notify md (because they may want more potassium, more tests, need to change medications, etc).

    Many meds can effect potassium levels. So can hydration and organ function (or more like dysfunction).
  6. by   Elyse545
    So I wrote the question wrong. It wasn't a critical potassium. Obviously I would call on a critical potassium, I'm not sure why I used that word. It was a high potassium but it wasn't critical. I am tired, it has been a really long week.
    Last edit by Elyse545 on Feb 14
  7. by   cleback
    Quote from Elyse545
    So I wrote the question wrong. It wasn't a critical potassium. Obviously I would call on a critical potassium, I'm not sure why I used that word. It was a high potassium but it wasn't critical. I am tired, it has been a really long week.
    Because potassium doesn't have a lot of wiggle room before encountering cardiac problems, I tend to have a low threshold for reporting K values, even when they are not critical. The exceptions are if patient is on a high dose furosemide and the provider is already aware levels are low and actively replacing... or if they're end stage renal patients and getting dialysis. Then I may call only if it's below 3.2 or above 5.4ish.

    Just the other day, I had a patient with a K of 5.6 (high cutoff is 5.1 at my hospital, critical I believe is 6?). The patient was on K replacement TID. I questioned the day nurse on it, and she didn't have an answer so I called the provider. It turned out that the provider just somehow missed the result. The patient ended up getting furosemide, a fluid bolus, an EKG, and a K recheck later that night. The physician was appreciative that I called him.

    When in doubt, call the doc, especially on K!
  8. by   OrganizedChaos
    Quote from chare
    At my facility, the nurse is notified by the lab of all critical values. The nurse is then required, by policy, to notify the physician of all critical values within 1 hour of receipt. The physician can also write an order to be specified of specific values, regardless of whether it was a critical value, or not. Again, the expectation is that the physician be notified within 1 hour.
    Same here. If the lab calls with a critical level we have an hour to call the doctor, need to document the call & critical level.
  9. by   Buckeye.nurse
    Quote from cleback
    Because potassium doesn't have a lot of wiggle room before encountering cardiac problems, I tend to have a low threshold for reporting K values, even when they are not critical. The exceptions are if patient is on a high dose furosemide and the provider is already aware levels are low and actively replacing... or if they're end stage renal patients and getting dialysis. Then I may call only if it's below 3.2 or above 5.4ish.

    Just the other day, I had a patient with a K of 5.6 (high cutoff is 5.1 at my hospital, critical I believe is 6?). The patient was on K replacement TID. I questioned the day nurse on it, and she didn't have an answer so I called the provider. It turned out that the provider just somehow missed the result. The patient ended up getting furosemide, a fluid bolus, an EKG, and a K recheck later that night. The physician was appreciative that I called him.

    When in doubt, call the doc, especially on K!
    I think cleback nailed the reason the doctor wanted to be notified. The medical team missed the fact that a patient with a borderline high K level was still getting potassium replacement. Nurses are often the ones that catch these type things that slip through the gaps (like the situation Cleback described).

    We're busy, and have a ton of things going on, but it's always a good idea to take a sec and check lab values before giving certain medications (platelet level before subQ heparin, INR before coumadin, HR before digoxin, K level before supplements or diuretics...the list goes on). Just my 2 cents.

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