Highest/Lowest K+ you've ever seen

[guest769224]

I work in an ICU and we had a 28 year old male life flighted to us with a K+ of 1.3. Not a typo.

He had no diet abnormalities and no family history worth noting.

He flat lined on the flight, briefly, no cpr, and came to us talking and cracking jokes... I was a little stunned. The attending physician ordered 40 of K+ to be infused and the pump refused because of the abnormally high level...the nurse told me she programmed it to run as normal saline. Patient then overshot and his level jumped to 6.1 after that.

And the whole time he was bradycardic in the 20's and tachy in the 130's. Staff had all the code drugs in the room as he kept chitter chatting. They inserted a central line.

Very interesting for me to observe as a student...what has everyone else seen?

[Guest03/15/15, BSN, RN]

We used to have a young man who had some type of disorder where he literally took 80 meq of k+ TID po. I've had him come in nearly paralyzed at 1.5. He was in mid 20's - haven't seen him in a couple years - hope he's all right. Highest potassium was probably low 7's - was a man who missed one too many days of dialysis and ended up coding. Once we got him back he went for emergent dialysis.

[dirtyhippiegirl, BSN, RN]

My mom lost muscle function with a potassium of 1.4. Thankfully in her legs and not her heart.

[CountryMomma, ASN, RN]

6.5 - she came in because she had a fall and broke her wrist. The k+ finding was coincidence and I've never hovered over the dumb waiter so anxiously waiting for insulin and Calc gluconate.

Lowest was 2.1. They stat tubed the kcl up, and I busted my tuchus getting it running in no time flat. Tele kept calling, I kept telling them I was in the danged room looking at the pt. He was chatting away with his gf.

Good times.

[Meriwhen, ASN, BSN, MSN, RN]

2.1, eating disorders patient that got a fast-track ride to the ER.

I can't recall the highest I've seen.

[blackvans1234]

7.8 upon presentation to the ED, 6.7 prior shift and 6.2 on mine.

:-O

Never got a chance to see the peaked T waves!

[SierraBravo]

The attending physician ordered 40 of K+ to be infused and the pump refused because of the abnormally high level...the nurse told me she programmed it to run as normal saline. Patient then overshot and his level jumped to 6.1 after that.

If you meant 40 as in 40meq, then 40meq of K is not going to make the patient's K go from 1.3 to 6.1. If it did, then one of those lab draws was wrong.

The reason the pump wouldn't allow the nurse to program in 40 of K is because you can only run 20meq of K per hour. Even if you supplement with IV & PO potassium concurrently, you can still only safely give 20meq per hour.

[loveofrn, BSN, RN]

If you meant 40 as in 40meq, then 40meq of K is not going to make the patient's K go from 1.3 to 6.1. If it did, then one of those lab draws was wrong.

The reason the pump wouldn't allow the nurse to program in 40 of K is because you can only run 20meq of K per hour. Even if you supplement with IV & PO potassium concurrently, you can still only safely give 20meq per hour.

The preferred maximum concentration for severe hypokalemic patient on cardiac monitor is 40 mEq/hr KCL by IV and it can be increased up to 80 depending on the situation.

[dah doh, BSN, RN]

Highest K I've seen was over 9. Pt had huge peaked T waves that looked like tombstones. Pt's rhythm progressed to idioventricular, coded, and died.

My dialysis nurse friend saw a K over 10 and survive. Said the pt lived with higher K as a norm...somewhere about 7-8 was usual for that pt.

Lowest K...can't recall the exact #, but the pt was symptomatic with muscle tone loss. I think I gave around 200 meq kcl throughout my shift (both oral & iv route) and the k was still low at the end of my shift. No cardiac changes though. Pt awake & talking.

[SierraBravo]

The preferred maximum concentration for severe hypokalemic patient on cardiac monitor is 40 mEq/hr KCL by IV and it can be increased up to 80 depending on the situation.

What is the source of that information? Do you work in a cardiac ICU? Are you saying that in your facility you can give 80meq of K over an hour? And obviously anyone who has a low K will (or at least should) be on telemetry. In my Institution the threshold is 2.5. So if the patient's K comes back at 2.5 or less they are automatically on telemetry.

Incidentally, 40meq/hr is not a concentration, it's a rate.

Edit: Just realized that loveofrn is a nursing student...

[RN_Sara]

I had a pt with 9.6. She coded. We got her back and then her POA withdrew care. She died about 20 minutes after we pulled the tube.

[TLSpaz, ASN, RN]

The highest I've seen was 9.2 and it happened last night; confirmed via ABG with lytes, which resulted at 9.1. Pt presented to triage with profound muscle weakness and a HR of 32; ended up having a trialysis cath inserted and was being admitted to ICU for emergent dialysis as I was leaving this AM.