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Help understanding reason for meds

Posted

Specializes in Critical Care.

Hi, I'm a fairly new nurse on a telemetry floor. I am not sure at the reasoning for some medications administered to a newly admitted pt.

The pt was ad,tired from ER for palpitations, sob, nausea, C/P.

Hx: afib, HTN, no hx of DM.

Labs: K+ 5.4, no other abnormal labs

Meds given in ED:

"Hyperkalemia cocktail"

Potassium chloride

Insulin 10units

Amp. D50

It was end of shift and my CN was already gone and the RN I asked for clarification with had no idea at the seeming counter productive med treatment. I go back tomorrow but was hoping someone could give me some clues. I'm not sure what I'm missing and of courses I feel like an idiot not beginning to see the sense of this.

Thanks for your time.

Kim

Rhody34

Specializes in Acute Care. Has 5+ years experience.

I'm also a new nurse working on a tele floor. I've seen this ordered many times for hyperkalemia. Insulin moves potassium back into the cells- in turn, lowering the serum potassium level- giving the kidneys time to excrete the potassium in the urine. The D50 is to prevent hypoglycemia (I think any way). Like I said- I've seen this ordered many times, it's pretty effective- however, I think the kayexalate seems to work better.... in my opinion any way.

Music in My Heart

Specializes in being a Credible Source. Has 11 years experience.

Are you sure the "potassium chloride" isn't calcium?

I've given the insulin/D50/kayexalate combo with calcium lots of times... never given it with potassium.

Rhody34

Specializes in Acute Care. Has 5+ years experience.

I thought she meant calcium as well!

kool-aide, RN

Specializes in Cardiac. Has 5 years experience.

Just learned this in school, something about the insulin...helps the K rush into the cells out of the blood while it's taking the glucose with it.

turnforthenurse, MSN, NP

Specializes in ER, progressive care. Has 7 years experience.

As for the calcium chloride, it helps "protect" the heart. The extracellular potassium is shifting into the cells thanks to the insulin, so this can potentially cause dysrhythmias.

Typically, calcium gluconate is used in this "cocktail," as it is less irritating. Calcium gluconate contains 9mg/mL of calcium (10% solution) whereas calcium chloride contains 27mg/mL (10% solution).

Also keep in mind that the insulin/D50/calcium gluconate combo is only temporary. Potassium will begin to leak back out of the cells after awhile. Therefore, the only definitive way to get rid of potassium is with Lasix, kayexalate or dialysis.

<3_RN

Specializes in Critical Care.

It was def relayed and confirmed as K+ which added to the confusion. Thanks for the responses. I'll know next time, always a larking experience.

D50 + insulin helps move potassium back in to the intracellular compartment and i guess it was calcium gluconate.

Just a side note: in addition to the meds listed above, I've also given albuterol nebs to help lower a K > 7. The drop alone isn't drastic, but helps to treat hyperkalemia emergently in combination with the other meds.

turnforthenurse, MSN, NP

Specializes in ER, progressive care. Has 7 years experience.

Just a side note: in addition to the meds listed above, I've also given albuterol nebs to help lower a K > 7. The drop alone isn't drastic, but helps to treat hyperkalemia emergently in combination with the other meds.

I have also given albuterol to help lower K+, though this isn't as popular as the other hyperkalemia cocktail.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

I have NO IDEA why Potassium was given....I hope the MD didn't get confused. I would have questioned the order.

The "cocktail" is....

Calcium Chloride: use chloride in code/shock as gluconate requires hepatic conversion

Insulin/Glucose-20 u and D50

Albuterol-10 to 20 mg

Bicarb-1 mEq per kg in acidotic pts...in the IVF

http://www.kidneynotes.com/2006/01/treating-hyperkalemia-high-blood.html

Meds given in ED: "Hyperkalemia cocktail" Potassium chloride Insulin 10units Amp. D50 It was end of shift and my CN was already gone and the RN I asked for clarification with had no idea at the seeming counter productive med treatment. I go back tomorrow but was hoping someone could give me some clues. I'm not sure what I'm missing and of courses I feel like an idiot not beginning to see the sense of this. Thanks for your time. Kim

I have given insulin/D50 many times for hyperkalemia. I will monitor glucoses more closely for awhile. When I get an order for kayexalate I usually try to get the order changed to insulin/D50. Kayexalate for a renal patient has been associated with intestional ischemia.

flymedicRN24, BSN, MSN, EMT-P, APRN

Specializes in Flight Nursing, CVICU, ICU.

Calcium Cloride is given to raise the action potentional threshold to help prevent Vfib

delphine22

Specializes in Quality, Cardiac Stepdown, MICU. Has 5 years experience.

What everyone else said about the cocktail.

I know you didn't give this treatment, you just heard about it thirdhand, but this is a very important lesson for a new grad.

ALWAYS better to question and feel stupid (though no one thinks you are) then ignore something that doesn't seem right.

You obviously realized that it doesn't make sense to give potassium to someone who's hyperkalemic, even if you didn't immediately understand the mechanism behind the insulin/D50.

If a doctor gives you that order, speak up. "I'm sorry, did you mean to give potassium for the hyperkalemia?" Doctors are not perfect, and they often misspeak, and blind adherence to what you hear does not protect you from a bad outcome.

Don't be afraid to speak up!