Published Jan 8, 2002
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.
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?)!!
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
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?
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???
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.
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