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Discussion

Pediatric Question

The physician orders the following order for fluid replacement on a patient diagnosed with acute gastroenteritis: Start D5 ½NS with 20 mEq KCL at maintenance. Before hanging the IV fluid which of the following assessments would be most important?

The question above has two answer choices that are giving me trouble. The first one is documented urine output and the other is Baseline EKG. I'm thinking baseline EKG given the fact that potassium has cardiac effects and you'd want a baseline to determine what's abnormal but I also think urine output is important because you'd want the child to be able to excrete the solutes.

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    How many pediatric EKG's get ordered on your unit? The reason I'm asking is I have a serious amount of pediatric experience and I've never seen an EKG done prior to initiating fluids of any kind. In fact I could probably count on one hand the number of peds EKGs I've ever seen done (other than monitor strips) on non-cardiac kids. All that being said this is the testing world and we all know what that means. I'm curious to know what you have experienced at your facility.

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    Urine output. Adequate urine output must always be documented prior to hanging potassium.

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    Hmm... I haven't hung potassium in a few years but i would assume the urine test to assess current K+ levels and confirm normal kidney function? I don't know - what are the other choices that you think are definitely wrong?

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    I think it's urine output because you want to make sure the kidneys can flush excess K out

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    That's a very small amount of KCl and that is a very common IV fluid you will see ordered in pediatrics. It's running at maintenance. You don't need an EKG. I've never even seen an EKG ordered prior to a KCl bolus. You do, however, need to ensure adequate urine output. "No pee, no K" was our saying when I worked inpatient.

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