giving D50 for hyperkalemia

Twinmom06, ASN, APN · May 13, 2015

I've only ever pushed it. Usually its 10 units of IV Novolog push and a half amp (half of one of those huge syringes) of D50 in a non diabetic patient.

Altra, BSN, RN · May 13, 2015

Just push it.

Twinmom06, ASN, APN · May 13, 2015

Just push it.

push it real good.....

NurseOnAMotorcycle, ASN, RN · May 13, 2015

Yup, just push it in, doesn't need to be over a certain amount of time. The important part of the equation, though is the INSULIN. Insulin hides the extra potassium in the cells (just like sugar) until kayexelate can work and actually get the extra potassium out of the system entirely so the pt doesn't go into dangerous arrhythmias from a high potassium level.

So the equation for a dangerously high potassium level is:

D50+ insulin+ kayexelate= repeat potassium lab

Also, if any patients are getting insulin fopr glucose levels (especially drips!), you should really check their potassium levels to make sure it won't drop to unsafe levels. PO or IV potassium may be ordered to buffer it.

TiffyRN, BSN, PhD · May 13, 2015

push it real good.....

Yea, last time I did that was SOOOO long ago cause we don't do this in NICU. To emphasize how long ago, I was instructed by a dialysis nurse that I should poke both the needles (yes, that would be those pointy sharp things) into the rubber (I'm sure it was non-latex) hub of the IV and intermittently inject them, like 4-5 mls of the D50, 1-2 units of the insulin, until it was all in. Pretty quickly, all of it within a couple of minutes. You didn't want to inject the insulin into a long length of tubing d/t it absorbing into tubing.

NurseT88 · May 13, 2015

an online EM forum I found this, is anyone practicing this standard? :

10 units of regular insulin bolus, followed immediately by 50 mL of 50 percent dextrose (25 g of glucose) is inadequate! This regimen may provide a greater reduction in serum potassium since the potassium-lowering effect is greater at the higher insulin concentrations attained with bolus therapy. However, hypoglycemia occurs in up to 75 percent of patients treated with the bolus regimen, typically about one hour after the infusion. To avoid this complication, infuse 10 percent dextrose at 50 to 75 mL/hour or give 2 amps of D50 (50 grams) and ensure close monitoring of blood glucose levels.Update: One of the commenters below asked for a reference for the up to 75% statistic. Took some time to track it down, but it is this article (PMID: 2266671). This article showed a markedly lower, but still worrisome percentage in gen pop. Most of those events were with the 1 amp regimen (PMID 22489323). This one showed an incidence of 13% (doi: 10.1093/ckj/sfu026).

NurseOnAMotorcycle, ASN, RN · May 13, 2015

Feed the patient. It doesn't always have to be a medication. Sometimes I think we forgot how to be nurses.

(edited to add: Please forgive me, I should have clarified that my comment was directed towards the quote, not directly at NurseT88)

nrsang97, BSN, RN · May 13, 2015

I have always given the 10 units of insulin followed immediately by the D50 IV push.

blondy2061h, MSN, RN · May 13, 2015

We give an amp of D50 pushed over 17 minutes. We'll give the 10 units of Regular IV push if they've been having high blood sugars or have diabetes. Current recommendations are that if they have normal blood sugars and aren't critically ill, allow them to make their own insulin to cover the dextrose.

OCNRN63, RN · May 14, 2015

push it real good.....

Oooh, baby baybee, baby baybee...

loveu123 · May 14, 2015

We give it all the time in the ED for hyperkalemia and you just gotta push it.