i need help learning about burns and hyperkalemia and IVs

hypocaffeinemia, BSN, RN · Mar 7, 2009

i don't get it.. what does it mean when a person has a burn and the K+ spills out into the cell? which causes.. what? hyperkalemia? someone explain?

Hyperkalemia in burns is the result of three related pathways:

1) Damaged cells spill their cytosol, rich in K+, into surrounding tissue. Increased capillary permeability as a result of the inflammatory process allows for K+ to shift intravascularly.

2) The significant amount of damaged tissue as a result of the burn releases a large amount of uric acid, myoglobin, and other protein and protein metabolism components into bloodstream. This results in metabolic acidosis, which causes normal cells to exchange K+ for hydrogen ions in an effort to reduce the acidosis.

3) Metabolic acidosis combined with excessive myoglobin from muscle destruction strains the kidneys. Acute renal insufficiency/failure can result, thereby causing less K+ to be excreted.

It is important to note that all of the above are in the immediate acute stage. After several days as things start to normalize, a rapid swing towards hypokalemia can result due to K+ shifting back intracellular, assuming stabilization of inflammation, kidney function, and acidosis occur.

0.9% NaCl is used for diabetic patients... why?

This statement is too vague. Generally, you avoid giving diabetics things with sugar (D5 combinations), but it's not a hard and fast rule (see treatment for DKA).

Lactated ringers is isotonic and used for surgical patients with just blood loss? please help.

This statement is also too vague. If you intend to give fluid for pure volume replacement, isotonic fluids such as LR or NS are used. LR is preferred over NS when giving laaaaarge amounts of fluid fast as it doesn't cause a hyperchloremic acidosis, which NS can cause.

RedCell · Mar 7, 2009

Being burned causes damage to cell membranes which causes normally intracellular electrolytes (potassium being one) to spill into the the extracellular fluid. This is what causes hyperkalemia.

Normal saline is one of many fluids that can be used on diabetics, it sounds like someone wants you to acknowledge that there is no dextrose in this solution.

Lactated ringers is commonly used in surgery because it closely resembles blood plasma. Plasmalyte is also acceptable. The reason LR is used over normal saline is due to the fact that hyperchloremic acidosis can occur with high volumes of normal saline replacement. To further this discussion a common debate for acute blood loss is the old rhetorical colloid vs crystalloid administration for acute blood loss.

hypocaffeinemia, BSN, RN · Mar 7, 2009

To further this discussion a common debate for acute blood loss is the old rhetorical colloid vs crystalloid administration for acute blood loss.

Heh. What's the standard of care this week? :)

Last I heard, colloids showed no real efficacy over and above crystalloids.

RedCell · Mar 7, 2009

Heh. What's the standard of care this week? :)
Last I heard, colloids showed no real efficacy over and above crystalloids.

I think there are too many papers, opinions etc... to give a straight right or wrong answer. Judging when to give colloids or crystalloids should be based on the patient's known prior history, amount of blood lost, and what you are looking at when put in this position. For large volumes of blood loss, whole blood is the best replacement. Unfortunately, this is not usually a viable option. The most up to date literature is coming from the war in Iraq. For massive blood loss the current recommendation is to replace at a ratio of 1:1:1 (packed red cells, plasma, platelets). Blood banks do not like this because it depletes their supply. I guess the best answer would be for the practitioner to take what they can get and for the patient to not get shot, stabbed, empaled, amputated, or eviscerated.

BerryHappy · Mar 7, 2009

OMG you guys make me feel like an IDIOT! :uhoh3:

Thanks for the lesson...when I grow up I wanna be Y'ALL!!! :bow:

allnurses Guide · Mar 9, 2009

i don't get it.. what does it mean when a person has a burn and the K+ spills out into the cell? which causes.. what? hyperkalemia? someone explain?

Just watch your thought - K spills OUT OF the cell, not out into the cell. ie. out of the cell and into the bloodstream, which leads to a high serum K=hyperkalemia.