Potassium baths- dialysate

idodialysis · Jun 14, 2015

If you consider the serum potassium level , normal is 3.5 to 5.0. A renal failure patient may be 6,7,8,9 and a patient who is not eating(ie, in icu and not receiving replacement K may be low. The potassium in the dialysate can be manipulated to lower or increase the patients serum K. So for a high K you use a low K "bath" to dialyze out excess potassium and for a low serum K you use a high K bath to supplement serum K.

Bluebell. · Jun 15, 2015

Thanks for the clarification!

nurseprnRN, BSN, RN · Jun 15, 2015

Remember what you know about semipermeable membranes. An electrolyte like K+ will move through one from an area of higher concentration to an area of lower concentration. So... if the patient's blood has a K+ or 3.0 (I know, like you're ever gonna see THAT in dialysis, but bear with me), if the dialysate on the other side of the membrane is also at 3.0, then there will be no movement of K+ from the patient's blood to the dialysate.

If someone has a K+ of 6.8 (more like it, huh?), his K+ will move out more rapidly across the semipermeable membrane if the dialysate is K+=0 than if the dialysate K+ is 3. Sometimes rapid shifts are good, sometimes more gradual shifts are better, in which case it might be a better idea to use dialysate with K+ = 3.0.

Conversely, if the patient's K+ is 2.1, a dialysate of 3 will increase it as K+ moves from the area of higher concentration (3.0) to the area of lower concentration (the patient's own 2.1).

jayjaybsnrn, MSN, APRN · Jun 16, 2015

I have never seen a patient or order that is 0 K. That will make pts complain of severe cramping and worst case scenario, dysrrhythmias. Nephrologist nowadays never use potassium free bath.

In our clinic the standard bath is 2K for patient who has stable potassium or within normal range.

1K bath for those who has >5.0 K+

3K bath for thosw who has

It doesnt mean if the pt has serum K+ of 3.0 and has a bath of 3K will not elevate the pt's serum K+, 3K bath is a very potent potassium and can increase pt's K+ immensely.

Rocknurse, MSN, APRN, NP · Jun 16, 2015

I have never seen a patient or order that is 0 K. That will make pts complain of severe cramping and worst case scenario, dysrrhythmias. Nephrologist nowadays never use potassium free bath.
In our clinic the standard bath is 2K for patient who has stable potassium or within normal range.
1K bath for those who has >5.0 K+
3K bath for thosw who has
It doesnt mean if the pt has serum K+ of 3.0 and has a bath of 3K will not elevate the pt's serum K+, 3K bath is a very potent potassium and can increase pt's K+ immensely.

Not necessarily. We used 0K baths often but only for the patients with the highest of Ks. Would definitely exercise caution when using them. However, 3K baths were the most frequently used baths in my unit. Even for patients with moderate to high Ks. I think it's nephrologist specific. Also, it may depend if you're working in an acute vs a chronic environment. I worked acutes and we would tend to be a bit more aggressive sometimes with the acutes, and far too generous with chronics.

jayjaybsnrn, MSN, APRN · Jun 17, 2015

Not necessarily. We used 0K baths often but only for the patients with the highest of Ks. Would definitely exercise caution when using them. However, 3K baths were the most frequently used baths in my unit. Even for patients with moderate to high Ks. I think it's nephrologist specific. Also, it may depend if you're working in an acute vs a chronic environment. I worked acutes and we would tend to be a bit more aggressive sometimes with the acutes, and far too generous with chronics.

Im with you on that one. Acute dialysis can be aggressive with baths, but not enough pulling of fluids though. Chronic have to be slow cooking type of treatment that needs to be good in the end.

TheCommuter, BSN, RN · Jun 17, 2015

This thread has been moved to the Renal / Dialysis forum to increase the chance of amassing responses from nurses who are knowledgeable about this topic.

Bluebell. · Jun 17, 2015

Thank you all for your help. This is making a lot more sense to me!

Chisca, RN · Jun 18, 2015

Since you're thinking about the potassium in the bath you should also consider the other chemicals and their effect. The sodium of 138. The bicarbonate of 33. The glucose of 100. For example running a patient who is acidotic on a low potassium bath is a recipe for disaster.

NurseRies, BSN, RN · Jun 19, 2015

I work for an acute team that is run by physicians. We actually just implemented a new policy that we are not allowed to use 1K baths ever. And 0K? No way, that was years ago. I guess every physician is different. But we have a team of about 19 physicians, they can only order 2-4 K baths.

4everpurple · Jun 25, 2015

Yes, for us standard is 2K+ or 3K + baths. We have a non formulary order for 1K+ but it is nephrologist specific, no one in our clinic is on 0K. We are a chronic facility....