I was just wondering if anyone has ever bolused K+? I had pt a few weeks ago that I was getting ready for a c-sec.....not a real emergent one (baby was breech). After recieving pre-op labs back.....her K+ was found to be 2.4.... this was rechecked by lab 3x. The md ordered......40meq K+, with 10cc of 1% lidocaine in a 250cc bag of LR to be bolused. Then to recheck K+ after bolus. Nothing else......no EKG or anything. Pt was fine too.....
Well I'm a fairly new RN......and I remember being told in school to never bolus K+. Another rule I read was not to give more than 10meq in an hr.
Needless to say I didn't bolus it......Of course the md was ticked.....
To repeat what everyone has said. I too give K bolus quite frequently. Usually 10 mEq/hr via per peripheral IV and 20 mEq/hr via central line. She should be on a monitor. However with my renal folks they are usually hyper- not hypo-. We do monitor if >5.3 although I usually get an EKG just to cover my bases (aka a$$). Had a renal pt the other evening admitted for hyperkalcemia, she was walking and talking just fine so I figured it was 5.5 or so.....but it was 9.0!!!!!!!!!!!
Originally posted by MPHkatie
We have a specific protocol for giving K and mag at our hospital and it has come in handy.
I called a resident the other morning with a Mg of 1.5. She said 'Give 2 grams Mag over 15 minutes', I said 'Excuse me??!!'; her reply was 'In the book it says you can do that', i went on to tell her I was sure that was in code situations and that we usually give 2 gm Mag over 4 hours, she said do what ever your comfortable with.
Never be afraid to speak up. You did the right thing.
I've given straight K in a PICU via continuous drip, but it was diluted with the various pressors, in a central line etc.
I beleive that our policy says we "can" give 20mEq/100cc over an hour in a PIV but have never done it. Frankly I've only met one pt who could tolerate 10 mEq/100cc over an hour. Couldn't ever give it faster.
RN,@yourcervix.....
misti_z
375 Posts
To repeat what everyone has said. I too give K bolus quite frequently. Usually 10 mEq/hr via per peripheral IV and 20 mEq/hr via central line. She should be on a monitor. However with my renal folks they are usually hyper- not hypo-. We do monitor if >5.3 although I usually get an EKG just to cover my bases (aka a$$). Had a renal pt the other evening admitted for hyperkalcemia, she was walking and talking just fine so I figured it was 5.5 or so.....but it was 9.0!!!!!!!!!!!
I called a resident the other morning with a Mg of 1.5. She said 'Give 2 grams Mag over 15 minutes', I said 'Excuse me??!!'; her reply was 'In the book it says you can do that', i went on to tell her I was sure that was in code situations and that we usually give 2 gm Mag over 4 hours, she said do what ever your comfortable with.
Never be afraid to speak up. You did the right thing.