Potassium Chloride IV

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Can administration of K+ 10mEq/100cc N/S (level 2.9) irritate myocardial muscle and cause extension of an MI?:idea:

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Too much or too little serum K+ can cause myocardial irritability and put the pt at risk for arrhythmias. Giving 10meq of K+ for a level of 2.9 is very appropriate (pt likely needs more like 20-40 meq actually) and should not further potentiate an MI. Has the pt recently had an MI? In fact I'd think it'd be more important to maintain a normal serum K+ in a pt with recent MI to avoid the possibility of arrhythmias, which the pt is already at risk for b/c of the MI.

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The patient had a troponin I level of 0.039 upon admit with a 3.0K+level. 8 hour troponin I was 3.09, K+ level of 2.9. Physcian ordered 1/2 ns with 40K and a 10 meq run of K+ in addition to Metoporol 100mg p.o. 12 lead ECK showed minor ST elevation leads V2, V3, with ST depression lead II. IV K+ was stated at 100 mls per hour. 15 minutes into infusion, patient become flushed, diaphoretic, no c/o of chest pain. 12 obtained, showed major ST elevation most all leads. Senior nurse coming on at time of 12 lead analysis stated it was the IV potassium caused the extension of MI. Needless to say this has devestated me by her remark. She stated the K+ run should never have been administered.

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The patient had a troponin I level of 0.039 upon admit with a 3.0K+level. 8 hour troponin I was 3.09, K+ level of 2.9. Physcian ordered 1/2 ns with 40K and a 10 meq run of K+ in addition to Metoporol 100mg p.o. 12 lead ECK showed minor ST elevation leads V2, V3, with ST depression lead II. IV K+ was stated at 100 mls per hour. 15 minutes into infusion, patient become flushed, diaphoretic, no c/o of chest pain. 12 obtained, showed major ST elevation most all leads. Senior nurse coming on at time of 12 lead analysis stated it was the IV potassium caused the extension of MI. Needless to say this has devestated me by her remark. She stated the K+ run should never have been administered.

I have never been taught this or seen it, I've been taught that K+ replacement it necessary in MI (of course you never want to give a K+ infusion too rapidly, but it sounds like yours was appropriate at 10meq/hr (it was 10meq/100ml run at 100cc/hr, right? thought that's what I remember).

http://archinte.ama-assn.org/cgi/content/abstract/147/3/465

I'm always open to learning new things, though, so if anyone has any further input on this please share!! Please correct me if I'm wrong.

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Also, with the elevated troponin levels and ST elevation in contiguous leads, should this patient have gone to the cath lab? What happened with the patient?

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Specializes in Critical care.
Can administration of K+ 10mEq/100cc N/S (level 2.9) irritate myocardial muscle and cause extension of an MI?:idea:

I'll say heck no.

I can't support your 'senior nurse' collegue's reasoning.

NOT replacing the K+ woulda been the error, as I see it.

This is just speculation, but I'll venture that 2.5 meq's of KCL (plus a negligible amt from the main bag) could actually be bolused without the effects you mentioned, let alone infused over 15 mins.

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Just a follow up on the patient. Yesterday (Saturday 1-12-08) afater Cardiologist saw her, she received a total of 5 runs of 10meq. Had a bedside echo done (EF 15%) global akensia. K= serum has never got above 3.2 throught the day yest and I admisisterd another run this morning prior to leaving. When I spoke to Cardiologist covering her last night wanting an update on her condition, I took the chance at a learning opportunity. I knew that a low Serum K+ can and will cause all sorts of CV difficulties. Cardio confirmed to me that I was right in administering the K+ run as ordered, and she said in all actuality if she would have been consulted prior to admit from the ER, she would have had them as an admitting order. My patient was admitted without any beta blockade, no Morphine for pain control, and not any of her home meds had been reordered through the Med Reconcil. When speaking to the family physician that admitted her throughout the night, I was sucessful in obtaining all the orders I needed. I have been a nure on Tele for 8 years and have done several shifts as swing in ICU. i can say that this was one case that made me loose precious sleep through the day yesterday dealing with my feelings and statement from superior nurse that by administering the K+ run, i extended her MI. I was especially calmed when I started last PM shift and found out all those runs she received were ordered through Cardiologist. Nursing is a continous learning experience. We learn from books, we learn from Doctors, patients. But,,,I know more than ever we also learn from our own hearts. Love to all that posted to me. I will keep you updated on her outcome, (although it seems quite gaurded at this time) but she was in "stable" condition when I left this am. Now its off to bed for I will pull another night and comfort her and her daughter as we attempt to pull her through this episode...........

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Specializes in icu/er.

not replace the k+... is your collegue joking?

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Specializes in ER, ICU, Transplant.

Just a thought... if the pt was losing that much K+ or at the very least not maintaining, what about her Mg++ levels, could also have been a cause for the ectopy... Or here's a thought; maybe it was the 2.9 K+ level alone?? The thought of not replacing a K+ level of 2.9; what kind of crack was that senior nurse smoking?? Well, here is my 2 cents: Just because they've been doing it longer doesn't make them a better nurse; so don't lose any sleep over it. :w00t:

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Specializes in Neuro ICU and Med Surg.
Just a thought... if the pt was losing that much K+ or at the very least not maintaining, what about her Mg++ levels, could also have been a cause for the ectopy... Or here's a thought; maybe it was the 2.9 K+ level alone?? The thought of not replacing a K+ level of 2.9; what kind of crack was that senior nurse smoking?? Well, here is my 2 cents: Just because they've been doing it longer doesn't make them a better nurse; so don't lose any sleep over it. :w00t:

I have to say that I completely agree.

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Specializes in gen icu/ neuro icu/ trauma icu/hdu.
The patient had a troponin I level of 0.039 upon admit with a 3.0K+level. 8 hour troponin I was 3.09, K+ level of 2.9. Physcian ordered 1/2 ns with 40K and a 10 meq run of K+ in addition to Metoporol 100mg p.o. 12 lead ECK showed minor ST elevation leads V2, V3, with ST depression lead II. IV K+ was stated at 100 mls per hour. 15 minutes into infusion, patient become flushed, diaphoretic, no c/o of chest pain. 12 obtained, showed major ST elevation most all leads. Senior nurse coming on at time of 12 lead analysis stated it was the IV potassium caused the extension of MI. Needless to say this has devestated me by her remark. She stated the K+ run should never have been administered.

10 mmol over 1 hr cause trop leak pah... If she was talking about st elevation due to too rapid k admin (also shown by global st elevation if i remember correctly) then maybe but i don't think that this would result in mi extension. additinally I figure that they would have got no more than 3-4 mmol in that 15 min. My unit usually give 20 mmol k over 1 hr in a 40 mmol/L bag ... so 15 min = approx 6 mmol /15 min at 100 mls/hr.

:hrnsmlys:

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
Just a follow up on the patient. Yesterday (Saturday 1-12-08) afater Cardiologist saw her, she received a total of 5 runs of 10meq. Had a bedside echo done (EF 15%) global akensia. K= serum has never got above 3.2 throught the day yest and I admisisterd another run this morning prior to leaving. When I spoke to Cardiologist covering her last night wanting an update on her condition, I took the chance at a learning opportunity. I knew that a low Serum K+ can and will cause all sorts of CV difficulties. Cardio confirmed to me that I was right in administering the K+ run as ordered, and she said in all actuality if she would have been consulted prior to admit from the ER, she would have had them as an admitting order. quote]

Was this patient's Mg low? You won't be able to get a person's K up if their Mg is low. Just making a guess on this guy, though.

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