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Hypoglycemic dialysis pt

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by jessrn12 jessrn12 (New) New

What is the best juice to give to a hypoglycemic diabetic dialysis pt? Taking into consideration the need to avoid high potassium foods, yet having symptomatic hypoglycemia. What is the best option for these pt's whom are not NPO. I have read both orange and apple juice have similar amounts of potassium, and cranberry doesn't seem to have enough sugar. I know milk also contains a fair amount of potassium. I have been in this situation a variety of times and feel unsure of the best option. The facility I work at treats hypoglycemia with PO intake vs. only using dextrose when the pt is NPO or unconscious.

ixchel

Specializes in critical care.

If it is early in dialysis, can't the additional potassium be corrected during? (Genuinely curious - dialysis is not my forte.)

I wonder if AcuteHD might know. I'll send him a link to here.

Farawyn

Has 25 years experience.

If it is early in dialysis, can't the additional potassium be corrected during? (Genuinely curious - dialysis is not my forte.)

I wonder if AcuteHD might know. I'll send him a link to here.

Acute is grounded right now, no links. Hopefully he'll see this.

FWIW, we always gave apple juice to our inpatient guys.

Apple juice with extra sugar and ghram crackers. We avoid milk due to the phos, but I would still give them some peanut butter for the protein. Per google, orange juice has 2.02 mg K per G, whereas Apple juice has 1.01 mg. Ixchel is correct that the additional K can be corrected, but Apple juice is preferred. Of course, in a hypoglycemic emergency we're not gonna sweat over a few extra mg of K or phos. If you give the peanut butter consider it a snack and give a binder as needed.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Along the same lines - how many dialysis units have glucometers? Or...do pts bring in their own glucometers? If the unit has a glucometer, how is it QC'd?

The opt clinic I was at and my acute clinic have a glucometer that is QC'd as part of the opening routine. It's only used on a PRN basis. I think Fresenius machines have an optional module for continuous BG monitoring, but I've never seen one.

ixchel

Specializes in critical care.

Along the same lines - how many dialysis units have glucometers? Or...do pts bring in their own glucometers? If the unit has a glucometer, how is it QC'd?

Our inpatient dialysis unit shares my unit's glucometers. One is docked at their door. They get QC'ed q24h on night shift by my unit's techs.

If you have supplements like nepro (like ensure for renal pts) give them that. Protein and sugar in it. We also have popcicles in fridge and candy.

In reality you most likely aren't gonna have a lot of "groceries" in an out patient clinic. Well unless you work where I do where one of the techs keeps it all in the fridge and cooks her meals there. Lol

We do have a glucometer in clinic for sure! Depending on type of glucometer depends when you QC them. Our policy is when you change solution or strips (which I change together and throw out together 90days after opened) or the meter has been dropped or its suspected it might need it. I typically do it weekly.

Chimera123, BSN

Specializes in ICU.

Usually in the chronic setting per my experience, you would not know that a patient is in a hypoglycemic episode until they show symptoms. They're usually asymptomatic esp DM pt's. Check the blood glucose then I give Novasource/Nepro/Ensure. Just like what the other poster said, it takes time to look for an apple/orange juice available, sometimes I ask for one from another patient's snack. lol. I give what we have in the floor asap. We QC our glucometers q24h. Thanks to the wonderful techs!

SmilingBluEyes

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis. Has 24 years experience.

In a true hypoglycemic EMERGENCY, they are getting D-50 IV. Followed up by a protein snack/NEPRO.

Apple juice or nepro is the best you should not give orange juice because if their potassium is already high it could cause a major problem