High K question

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

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

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.

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]

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

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.

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 ....

What if they're on a 4K bath?

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.

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....

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

This happened to me on call last month. They bring me the patient who is diaphoretic and somnolent. They said she's just hot and checked her BS and it was 75. She agreed that she gets sweaty sometimes and I was highly concerned about mental status, but her K was 6.7 and I had to get HD started. So I started her up... After she barely woke up after the first hour I had to beg the floor staff TWICE to bring a glucometer in. Her BS was 58! We got her to eat and drink, rechecked and it was still lower at 75. Patient stated that it hasn't been that low in years and she doesn't tolerate insulin well, she was frantic and ate so much food on top of two doses of Dextrose .. Finally came up. Patient had no memory of the last several hours and said that anything lower then 130 for her can be dangerous.