giving D50 for hyperkalemia

[NurseT88]

What is the standard way to give D50 for hyperkalemia? I'm not asking route, but the parenteral manual indicates IV direct is for emergency use only. Would you direct push the D50 for a potassium of 6.2? Or would you run an infusion? And if the option is to run an infusion - do you use a syringe pump? Or transfer the D50 into a minibag?

[SierraBravo]

Is nobody else pushing sodium bicarb with it? We always did an amp of d50, 10 units regular insulin, and an amp of bicarb. We pushed it as fast as we could, but you can only go so fast with those amps..

What's the rationale for pushing NaHCO3? The acidosis (if even present) will resolve once the K level decreases.

[misslindzee]

What's the rationale for pushing NaHCO3? The acidosis (if even present) will resolve once the K level decreases.

You got it.. It will only help if the potassium is high because of acidosis.

[iluvivt, BSN, RN]

( quote from above "D50 has always made me nervous. I had an experience of pushing it about 30 years ago, and the patient ended up hemolyzing in the vein, resulting in a compartment syndrome-faciotomy-leach trerapy- eventual amputation. D50 is very hyperosmotic. I don't know why it dosen't cause a hemolytic reaction every time it is given. That said- I'd push it slowly through an infusing IV at a brisk rate.")

Anything greater that 10% dextrose is considered a vesicant. This sounds like an extravasation. I am glad you brought this up. The high osmolarity of this drug contributes to the degree of the injury should it inadvertently escape into the tissue.Prevention is preferable to treating after the fact since many treatment options are controversial. So make certain your IV site is good and if in doubt take it out.

[CraigB-RN, MSN, RN]

Treatment of hyperkalemia in the ED

Hyperkalaemia

And you should be checking for blood return and that the vein is still canulated while giving the D50. Be careful and don't assume that one amp is going to be enough.