Kayexalate and D5 NS

[lifesabeach08]

OK, I'm a new graduate and I'm still orientating with a nurse. Well, the patient we were taking care of was on kayexalate and D5 1/2 NS. When transport came to take the patient to a procedure they asked whether she could be disconnected from the fluids or not, so I disconnected her, thinking she had not been hypoglycemic or anything and there was really no reason why she couldn't be taken off the fluid for an hour or two...right?

Well the nurse told me the Dr. prescribed the fluid in order to keep the patient from bottoming out from the kayexalate and I shouldn't have taken her off. Now, I've heard of giving an amp of D5 with insulin to lower potassium levels but never have I heard anything about D5 and kayexalate together.

Does anybody else know why D5 1/2 NS and kayexalate would be ordered together? I've mustered up all the critical thinking skills I possibly could and I'm still at a loss.

[GilaRRT]

Well, you would likely give D50%W with insulin in the adult patient not D5%W for treating hyperkalemia. As far as "bottoming out from kayexalate", it sounds like the nurse was pulling stuff out of her posterior. Not to say that the D5W should have been stopped, just saying the nurses excuse was pretty lame, as kayexalate works in the large intestine to replace sodium with potassium ions. It can have crossover to other ions (magnesium and calcium), however I have never know it to cause significant blood sugar changes.

Again, not to say you should have stopped the infusion.

[nrsang97, BSN, RN]

I completely agree with the above.

[Virgo_RN, BSN, RN]

I wonder if the nurse was thinking of hypotension as a result of fluid loss through the GI tract related to the kayexalate, and that keeping maintenance fluids running would prevent that?

[morte, LPN, LVN]

I wonder if the nurse was thinking of hypotension as a result of fluid loss through the GI tract related to the kayexalate, and that keeping maintenance fluids running would prevent that?

this is what i was thinking as well....bottoming out can be used to describe a dropping bp, as well as a dropping blood sugar