Kayexalate + Hyperkalemia

Published

Hi there -- Quick question.

In order to lower a high K+ level with Kayexalate, does there need to be a successful bowel movement (i.e. is the K+ excreted with the stool)

The reason I ask is that we have a patient w/K+ 5.4. She is receiving Kayexalate 15gm Q6h. Since she started (2 days ago) she has not had a BM yet (no cramping, Abd SNT, +BSx4). When we notified the MD, he said she did not have to have a BM for the Kayexalate to work on the K+.

The other nurses and I were under the impression that there needed to be a BM in order for the K+ to drop (thinking as in Lactulose + Ammonia).

Could someone clarify this for us?

(Mind you, this is a Geri/Psych unit to we don't see these things on a regular basis)

Thanks so much. :specs:

Up Vote Up Vote ×
Specializes in Cardiac Telemetry, ED.

I've seen K+ decrease after Kayexalate with no subsequent BM. The ion exchange occurs in the bowel, and I don't think it reverses just because the stool is still in the bowel.

Up Vote Up Vote ×
Specializes in Critical Care,Recovery, ED.

The K+ is absorbed and sequestered by the kayexalate until eventually eliminated by BM. It is a one way ion exchange.

Up Vote Up Vote ×

Update: 12/15 K+ = 5.4 , 12/17 K+ = 3.5 and still no BM. Worked like a charm!:yeah:

Up Vote Up Vote ×

I would be worried that the pt. is getting that much kay exalate 2 days running and hasn't had a bowel movement.

Up Vote Up Vote ×
Specializes in cardiac/critical care/ informatics.

There is no need for a BM for it to work. It pulls the K+ out. But if she has gotten that many doses I would be wondering if she had an obstruction or something. She should be having a BM with all of that Kayexalte in her system.

Up Vote Up Vote ×

God help the person she finally blows on.

Up Vote Up Vote ×

hahhaha, seriously!!! no blow over 11-7! we're working on the BM but she's been dehydrated and this is normal for her. we'll see what happens when i go in tonight. i'll prob end up being the lucky one!!!! :bugeyes:

Up Vote Up Vote ×
Specializes in Emergency.

I hate giving that stuff in the ED as they usually go with in a couple of hours of getting it. So to have a pt to no go at all you would get no complaints from me. I would after 2 days probably be asking for an abdominal series at the least to take a look at her belly to see whats going on.

R

Up Vote Up Vote ×
Specializes in Med-Surg.

Wow, I always thought that a BM was necessary for the K+ to decrease. Thanks for asking this question.

Up Vote Up Vote ×
Specializes in Trauma/ED.

One of those ED trade secrets...give the Kayexalate as you package up the patient for admit...not a minute before :)

Up Vote Up Vote ×

Larry, that is mean! Always had a feeling you ED nurses were doing that on purpose. Oh well, guess we would do the same. :)

Up Vote Up Vote ×
+ Join the Discussion