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Discussion

IV Dextrose in Hyperkalemia

Ok, this is really bothering me. I had a patient come in with complete anasarca possible ESRD, DM, HTN, needed to be dialyzed. I had to give him IV insulin and IV dextrose for his Hyperkalemia which was slightly elevated but the doctor wanted it anyway. He had a CVC so I pushed it through that. So here is what is bothering me I pushed the IV dextrose slow, obviously since you can not push it fast, but I was wondering if I did it too fast. It was probably pushed over 2 minutes with a few seconds break in between. Before I gave it to him I read the MAR instructions and there was nothing as to how long to push it. I flushed the cvc with two 10 ml syringes of 0.9. Did I push it too fast? His vitals were stable when I left but now I am obsessing over it. If so what could go wrong? Thanks!

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    • Featured Replies

    When in doubt, always check a drug reference like micromedex before administration of a drug that isn't familiar to you. Many facilities make one available on their intranet :)

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    • Author

    I asked the pharmacist and she said there were no special instructions for giving it.

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    When I push D50, I push it in over about 3-5 minutes as I'm doing this through a peripheral line and every so often I try to aspirate a little blood into the tubing. This is simply so that I can be reasonably certain that the vein hasn't blown and the D50 isn't infiltrating into the tissues. If I have the luxury of pushing it through a central line or a PICC, I'm going to push it over 2-3 minutes as I'm nowhere near worried about extravasation.

    Remember the D50 (or for that matter D10, as long as it's 25gm) isn't directly for the HyperK. You give insulin because that is known for shifting K+ back into the cells and the dextrose helps this process while also preventing the patient's blood glucose level from bottoming out.

    D50 is seriously thick stuff. You really can't push it fast...

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    • Moderator

    When someone's sugar is 20 or during a code, I push D50 as fast as I can as long as my IV is patent; it's so thick, so it's kind of self-limiting in that regard, you really cannot push it that fast. OP, I think you were probably just fine with your timing. The biggest side effect of D50 is — no surprise! — hyperglycemia.

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    If you push D50 through a peripheral line, the rationale for going slow is that D50 is a vesicant, so it should be pushed through a running line, and checked for patency periodically by aspirating for blood return. Since you were pushing it through a central line, this is not a concern.

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    You had a CVC - whats there to worry about? LOL

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    I push it as fast as I can - and develop my hand muscles in the process! For a short time our code carts were stocking vials of Dextrose that had to be drawn up with a syringe - it was torture to try and draw that up - especially during a code.

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