High K question

Published

I know dialysis patients have higher K then the general population. When we have dialysis patients come in through the ER due to the fistula being clogged. We do blood work. Then send them to to IR AND next to get their dialysis. My question is what potassium level makes a dialysis nurse uncomfortable ? Thanks

Up Vote Up Vote ×
Specializes in Dialysis.

With or without EKG changes? Anything above 6 gets my attention but tall, tented T waves with a high potassium level make me worry.

Up Vote Up Vote ×

No EKG Changes and no complaints from pt. K was a 7 with slight hemolysis.

Up Vote Up Vote ×
Specializes in Dialysis.

He will be fine until dialysis can be done. Kayexalate carries a risk of bowel ischemia. D50w/insulin will drive the potassium back into the cell and calcium gluconate offers cardiac protection.

Up Vote Up Vote ×
Specializes in Dialysis.
attachment.php?attachmentid=21689&stc=1
Up Vote Up Vote ×

Some of the doctors in my ER freak out with that K level on a dialysis patient. Even though we will be sending them to IR and then to dialysis. Also after all was done the patient came back to the ER with a K of 5.3. That made me happy [emoji4]

Up Vote Up Vote ×

In the general ESRD patient, I am much more worried over a borderline low K+, than an obscenely elevated one.

Up Vote Up Vote ×
Specializes in Nephrology, Dialysis, Plasmapheresis.
In the general ESRD patient, I am much more worried over a borderline low K+, than an obscenely elevated one.

Can you go into more detail on this?

I always "joke" that I'm not impressed until it's above 7.... Of course it depends on symptoms. Highest I've seen is 8.9, repeated numerous times.

Up Vote Up Vote ×
Specializes in Dialysis.

An acidotic diabetic with a borderline low K+. As you correct the acidosis with hemodialysis the potassium level falls. Throw some insulin in the mix and ....:dead:

Up Vote Up Vote ×
Specializes in Nephrology, Dialysis, Plasmapheresis.

What if they're on a 4K bath?

Up Vote Up Vote ×
Specializes in Dialysis.

4K+ bath is good but if their serum bicarb is 18 and your machine is set for 33 that is going to cause a rapid change in PH driving the serum potassium down. Fresenius was involved in a recall over this when they changed their bicarb concentration to a higher value and didn't inform their customers. Some docs will order the machine bicarb to be set lower if they think this is going to be an issue.

Up Vote Up Vote ×
He will be fine until dialysis can be done. Kayexalate carries a risk of bowel ischemia. D50w/insulin will drive the potassium back into the cell and calcium gluconate offers cardiac protection.

until the ER doesn't give them enough D50 and the pt's BG drops to 13 and they pass out....:banghead:

Up Vote Up Vote ×
+ Join the Discussion