High K question

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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

Specializes in Nephrology, Dialysis, Plasmapheresis.
until the ER doesn't give them enough D50 and the pt's BG drops to 13 and they pass out....:banghead:

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.

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Specializes in Dialysis.

You found out the hard way that glucose is easly removed by dialysis due to its small molecular size. Dialysis solutions used to contain 200mg/dl in glucose but with "tight" glucose regimens being all the rage it has been reduced to 100mg/dl.

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Specializes in Nephrology, Dialysis, Plasmapheresis.

Yes! Still trying to figure out the relationship between glucose, K, insulin, Ca, and acidosis! I know there's a lot to it... Got the basics but it is interesting. Just like the relationship between PTH, Phos, and Ca is still a little mind blowing. The kidneys do so much more then people could ever realize .

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Wow. Dialysis nursing just from reading all your posts scares me. I don't know if i could ever do it. [emoji4][emoji106]u guys Rock !

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Specializes in Dialysis Acute & Chronic.

One time a patient had a cardiac arrest--not on treatment or at the unit--he was revived and his K was 8.5. He was dialyzed and his since returned to the outpatient setting...after a CABG x4.

He told me he thought he was eating clementines--but happened to be oranges. He ate 3 of them. Then literately dropped dead a few hours later. These are the most frustrating patients, HD hx of 4+ years... and you are going to tell me you can't tell the difference between an orange and a clementine, and who told you you can have more than one in between treatments? There is less K in in clementines vs oranges. The patients know the dietary regs but still make poor choices.

They are told 1 and they think 100 is ok. Doesnt matter the units either... K or mL. LOL

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