Hyperkalaemia and saline

[Darknights]

Sorry about my English spelling and terms......

I wondered if there is any reason why the glucose infusion for hyperkalaemia can't be given via a pump in a 100mL (about half a cup) bag of saline. It would be possible to remove half the saline and replace it with the glucose. Has anyone done that?

We also administer Resonium (sodium polystyrene) but I just read that some say it should be given with several doses of sorbitol to enable defecation as this carries the potassium out of the body. Some say sorbitol increases the risk of colonic necrosis and some say Resonium on its own does.

[MattiesMama]

isn't 100% glucose really thick and hard to infuse? I've never given it but I was under the impression that it had to be given as a bolus, and it takes a lot of elbow grease to get it in someone.

[MassED, BSN, RN]

wouldn't hang normal saline. Likely insulin drip w/ glucose and Albuterol via neb. Usually provide IV Calcium gluconate and PO Kayexalate as well.

I have not used Sodium Polystyrene ... Sorbitol has been known to cause bowel necrosis/perforation in immunocompromised pts.

[Penelope_Pitstop, BSN, RN]

In my experience, D50 is given as a push following IV insulin because you're administering the insulin to a non-diabetic person whose own insulin is working fine, or a diabetic person whose glucose isn't all that high.

Insulin shock is a nasty thing and it can manifest before the IV bag would be finished infusing. Much quicker to push it.

[MassED, BSN, RN]

Mattiesmama,

D50 is usually given 1 amp (about 20 ml prepackaged I think) for hypoglycemia, and it is pretty thick - should have a good line, otherwise it can clot. I try to push it with some saline to dilute it a bit.

[Darknights]

Our 50% glucose comes in a mini-jet - 50mls. I read that you can inject the insulin directly through the blue plastic into the glucose. We have been asked by the latest young doctors to administer the insulin subcut though, just before the glucose infusion.

I wondered whether it is possible to add the 50% glucose to a small bag of saline and use the pump because we have to administer the 50mls over 15 minutes. It shouldn't be given at a rate more than 3mls/min. So I thought it would be a lot easier to use the pump to infuse it over 15 minutes.

:-) Sodium polystyrene is Kayexalate. We call it Resonium here in Australia.

Another thing I wondered about the glucose......is it common for patients to complain about stinging when the same IVC is used for other drugs later? Does the glucose cause irritation?

[Darknights]

BTW. Thanks for your replies. I work in a remote outback hospital and there is no such thing as policies or procedures. We wing it a lot of the time.

As my ward is for acute medical, chronic medical, psych, rehab, geriatric, palliative, cancer, detox.....basically anyone who isn't surgical....we often don't do some procedures very frequently and rely on each other to pool our limited knowledge. We don't have access to the internet or any texts to look things up either.

[Penelope_Pitstop, BSN, RN]

I wondered whether it is possible to add the 50% glucose to a small bag of saline and use the pump because we have to administer the 50mls over 15 minutes. It shouldn't be given at a rate more than 3mls/min. So I thought it would be a lot easier to use the pump to infuse it over 15 minutes.

Well, you don't want to add it to saline. You want that amp of D50 to be given as it is. And you want to observe the patient and watch the IV site. So if I'm in there watching the patient, observing the site...might as well be pushing the med...

[ckh23, BSN, RN]

You want to give the D50 IVP and then the insulin because of the hyperkalemia. It is a faster treatment to push K+ from extracellular space to intracellular, until the Kayeaxalte takes effect. The D50 is so thick that it will take some time to administer.

Giving it IV pump will run the risk of your patient going hypoglycemic if you have already given the insulin. As far as giving it subq, it will limit the effects of counteracting the hyperkalemia because the absorption will be prolonged compared to IV.

[MassED, BSN, RN]

Our 50% glucose comes in a mini-jet - 50mls. I read that you can inject the insulin directly through the blue plastic into the glucose. We have been asked by the latest young doctors to administer the insulin subcut though, just before the glucose infusion.

I wondered whether it is possible to add the 50% glucose to a small bag of saline and use the pump because we have to administer the 50mls over 15 minutes. It shouldn't be given at a rate more than 3mls/min. So I thought it would be a lot easier to use the pump to infuse it over 15 minutes.

:-) Sodium polystyrene is Kayexalate. We call it Resonium here in Australia.

Another thing I wondered about the glucose......is it common for patients to complain about stinging when the same IVC is used for other drugs later? Does the glucose cause irritation?

haven't had someone complain of vein irritation after glucose.

[MassED, BSN, RN]

BTW. Thanks for your replies. I work in a remote outback hospital and there is no such thing as policies or procedures. We wing it a lot of the time.

As my ward is for acute medical, chronic medical, psych, rehab, geriatric, palliative, cancer, detox.....basically anyone who isn't surgical....we often don't do some procedures very frequently and rely on each other to pool our limited knowledge. We don't have access to the internet or any texts to look things up either.

wow, that really is remote! It's fun, though, to learn without a ton of resources. Makes you appreciate the resources once you are working somewhere where you have them. Good luck!