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?
I saw my high and low within the last couple months. 1.3 and 9.0. Neither patient had much by way of EKG changes. 9.0 patient was a HD patient, I don't remember offhand what the other patient came in for.
The highest I saw was something like 12. Renal patient who constantly skipped dialysis and then tried to commit suicide by drinking a gallon of OJ. He was very nearly successful. He got energency dialysis in the ED, and then spent some time in ICU, then off psych.
Lowest was 1.7. My dad. He filled his pill box for the week and took all of his normal diuretics but forgot to put his K-dur in. And never noticed until by the end of the week he was in VT. That was his K at the ED.
Highest was in the 7s. She was a dialysis patient in her early 40s who really had no other issues than the fact that her body destroyed its kidneys. She was perfectly fine, chatting, laughing, marveling at how her K level went up when put on the hospital renal diet, good telemetry printouts. This, IMO, is what made all the difference. Most HD patients have comorbidities that make them more affected by high levels of things filtered out by the kidneys. She was also anemic due to her femoral graft bleeding out. I couldn't get over how the numbers and her presentation clashed so much from a clinical standpoint.
The lowest I have seen was 1.3, I think. It involved a critical care patient and lots of diuretics for various problems. We pretty much had to continuously hang bag after bag of 20 mEq KCL while also putting the liquid in the NGT with scheduled meds, along with enough albumin to make a few meringues. I joked that with the way things were going through the patient, I might as well have dumped half the KCl bags into the Foley catheter bag.
Also, has anyone here ever had IV KCl? I once read the account of an anorexic teenager who had been hospitalized multiple times and given IV KCl to save her. She described it as razors soaked in salt and alcohol being dragged through her veins, and she could feel it spreading to every part of her body as her circulatory system spread it. I definitely see it hurting through a peripheral IV.
11.2. Noncompliant dialysis patient as I'm sure you guys could guess. She lived - but I almost didn't live through the results of the ridiculous amount of kayexalate we gave her. Just saying.
Just in regards to KCl dosing - our protocol only lets us order 180 mEq/KCl per day and replacement for low K+ can be given every hour, but maintenance KCl has to be spaced out throughout the day. Our max doses are 20 mEq/hour IV or 40 mEq/4 hours PO. It can be challenging to replace someone with a very low K+. It is hard to get 180 mEq spaced appropriately, and we have to draw a K+ level after every 80 we give and wait for that to come back before we can continue with the next set of 80 mEq. It is a pain in the butt.
I just had my highest last week - potassium of 7.6. Tall tented t-waves. She was a type 1 diabetic in DKA with a blood sugar 1000+. After 5 liters of fluid and 20+ units of IV insulin her potassium dropped to 4.5. The t waves got shorter as time went on.
11.2. Noncompliant dialysis patient as I'm sure you guys could guess. She lived - but I almost didn't live through the results of the ridiculous amount of kayexalate we gave her. Just saying.
Almost can't wait till this new babe becomes widely available:
Just had my new high today. Potassium level of 8.0 without EKG changes! Went down to 6.2 after 10 units insulin, a gram of calcium, and an hour long albuterol neb.
11.something. The patient was a blind, demented, diabetic nursing home resident, a triple amputee whose sole remaining limb became gangrenous. This was back before DNR was legal - the poor soul died in CCU.
Highest was in the 7s. She was a dialysis patient in her early 40s who really had no other issues than the fact that her body destroyed its kidneys. She was perfectly fine, chatting, laughing, marveling at how her K level went up when put on the hospital renal diet, good telemetry printouts. This, IMO, is what made all the difference. Most HD patients have comorbidities that make them more affected by high levels of things filtered out by the kidneys. She was also anemic due to her femoral graft bleeding out. I couldn't get over how the numbers and her presentation clashed so much from a clinical standpoint.
The lowest I have seen was 1.3, I think. It involved a critical care patient and lots of diuretics for various problems. We pretty much had to continuously hang bag after bag of 20 mEq KCL while also putting the liquid in the NGT with scheduled meds, along with enough albumin to make a few meringues. I joked that with the way things were going through the patient, I might as well have dumped half the KCl bags into the Foley catheter bag.
Also, has anyone here ever had IV KCl? I once read the account of an anorexic teenager who had been hospitalized multiple times and given IV KCl to save her. She described it as razors soaked in salt and alcohol being dragged through her veins, and she could feel it spreading to every part of her body as her circulatory system spread it. I definitely see it hurting through a peripheral IV.
I've never had it, given it tons of times though. One time, I came into my unit to a patient screaming bloody murder..top of her lungs, 1st thing in the morning. I asked 1 of the night nurses what was going on w/her..as she was to be my patient later..turns out they had IV KCl running, peripheral w/o being further diluted with additional NS. Ran in there and hung a bag to run concurrent...screaming stopped and I had an extremely happy & appreciative patient. I think of her every time I hang it now.
smf0903
845 Posts
I saw my high and low within the last couple months. 1.3 and 9.0. Neither patient had much by way of EKG changes. 9.0 patient was a HD patient, I don't remember offhand what the other patient came in for.