High Potassium

Could someone explain the mechanism by which insulin + D50 lowers a high potassium level?

I was trying to explain it to another nurse yesterday and was unable to.

Thanks!

[CANRN, MSN, RN]

The insulin is capable of shifting the K+ back into the cells, decreasing extracellular K+ levels. The D5 is used to counter the potential hyperglycemia in response to the increase in insulin.

I worked in ER and we had a man come in who was in a servere hperkalemic state. I was amazed when the doc ordered this ( I was new to the ER at the time,) and equally amazed to see how effective it was. Pretty neat!

Hope this helps

[LilgirlRN, ADN, RN]

We use the same combo, sometimes with CaCl tossed in..sure beats the heck outta Kayexcalate (did I spell that right?)!!

[kewlnurse]

Bicarb work also, exchankes bicarb for the k+ ions, thats why you somtime see it used in a code, either way the k+ is excreted in your urine, imho kayacelate is USELESS for acute hypercalemia

[mattcastens]

Originally posted by CANRN

The insulin is capable of shifting the K+ back into the cells, decreasing extracellular K+ levels. The D5 is used to counter the potential hyperglycemia in response to the increase in insulin.

I know this part, but does anone know how the insulin pushes the K+ back into the cells?

[Jen911]

We've had this order a couple times in the ER and our debate has been which to give first, insulin or D50... Curious to see if our concensous was correct???

[Rainagrey]

I think insulin drives the K+ back into the cells by triggering the one of the ion pump mechanisms. K+ is the chief cation inside the cell, and there's a lot of transport through the membranes. BTW, this maneuver is only temporary - the K+ will come back out into the plasma sooner or later, and when that happens you need to have a dose or two of Kayexelate in the gut, ready to catch it.