Potassium IV solutions

[Sarah010101]

Hi everyone,

I need some help with something that happened on the medical unit today, my pt was admitted for liver failure and had a history of alcoholism. Upon receiving the patient I went to look at the morning labs and collect my usual information. I noticed however that the potassium level was at 2.6!... extremely low. Anyways so i went hunting around for information trying to figure out if the LPN had called the doctor or if anyone was aware. After I called the doctor he told me to start the pt on NS with 40 KCl.... However at 0800 I had already administered 1200 mg of potassium supplements. I didnt even THINK of this as I set the IV pump and went on with my day.

As soon as went to give the 1000 meds I noticed that I had given the 1200 mg of potassium and that the pt was also on KCl IV as well.

Long story short the pt was ok, but i was wondering what you would have done, since i had no orders to stop the potassium supplements, i know i should have informed the doctor that i had given them.

Close call.. NEVER doing that again.

[wooh, BSN, RN]

It takes a bag with 20 mEq KCl to basically stay normal. If you're givimg IVF that has less potassium (perhaps 10 mEq), you're likely going to slowly drop your level, if you give above 20 mEq KCl in your IVF, you'll SLOWLY raise it.

Nothing you did sounds off to me. Before calling a physician to report a critical K value, I'd make sure I had their other electrolyte values in front of me, along with their medications (especially supplements and diuretics.)

But like I said, it doesn't sound like you did anything abnormal giving oral potassium supplements along with what is just a tiny bit extra IV potassium in the fluids.

[April, RN, BSN, RN]

If the patient takes 1200mg of K+ daily and he was still at 2.6, then he needed something in addition to that daily dose... which is what you did by giving the IV K+.

[Sarah010101]

Well.. I spoke to my manager, and she cant even figure out why the CNE wrote me up. But the way everyone was discussing the situation I thought I had made a HORRIBLE mistake. I did get the updated KCl values though... they only went up to 3.2... so obviously no harm done to the patient.

And the KCl was being run at 125 cc/hr. Anothe reason why i could not figure out what I did wrong. But i spoke to the CNE and she said that i had to critically think more about what I was doing... meaning I did not think about when i started the pt on KCl... and I had previously given potassium as well.

And 2.6 was GOOD for this pt. When they came in all electrolytes where extremely low to the point where he was not even responding.

Also, I did call the doctor, but I failed to mention that I had given the pt potassium supplements prior... which is where the CNE comes in screaming at me... yes i should have had all of my information ready, and yes I should have informed him since it is important... but i didnt, and i know what i need to do next time.

Anyways incident report has been dropped... and now that my semester is over im doing some research about this particular situation and figure out what exactly this potassium supplement was... i swear it said 600 mg.. and i gave 2 as per the MAR.

Thanks for everyone's help :)

[Fiona59]

Are you talking about the hospital CNE or the CNE from your Uni?

Hospital CNEs are under pressure to justify their continuing existence in my facility. So we are getting bombarded on a daily basis with "information" emails that exist only to provide a trail of "proof of life in their offices".

If it was your CNE from Uni then I'd say it's fairly obvious why they did it.

[Sarah010101]

Yes it was my unit CNE...

I work on a Medical Unit, only 28 beds... the hospital is going to be shut down soon,

and the community is trying to keep the ED open so we dont have to drive 20 mins

to a nearby newer hospital. (I am near Vancouver, BC).

But yeah, I find they go around an nitpick at everything. For example,

I call them aligator clamps for the IV tubing... they are the little connecting pieces,

i dont use them because pt's can wrip them off so easily and then there is IV fluid

all over the floor rather than in the pt. So i use the screw on ones.. which i think

are safer and more secure. However whenever the CNE disagrees with me she threatens

to "take the proper course of action for the incident" and here I am thinking, WHAT INCIDENT!?

And yes we get emails about evidence based practice and we should do it this way and

not that way.

And yes I am ALL for learning the best way.,.. im only just finishing 2nd year...

and im thinking she is picking on me.. because it only seems to be me who

she threatens to write up.

[Fiona59]

Yup, they always seem to have one nurse in their range of vision. We swear that our service doesn't need an educator for every unit. The cutbacks have meant that they now service two or three units. Oh, the dreck they produce. I've had emails on making sure my CPR is up to date, cyto-toxic meds (yup, you fool, I passed the course and am certified, maybe you should look at your records), how if we need blood we have to go to lab, stuff we all know and pass onto students.

One eduator's written English is so poor that it's hard NOT to laugh when we get her emails. If anything she should be let go for mangling the English language, grammar is wrong, the phrasing makes you wonder how she ever got her degree and her style is high handed and arrogant. How she keeps her job is a mystery. She's also of the generation of RNs who thinks LPNs are lesser beings with low IQs. She'd have a fit if she ever read some of our resumes and checked our educational backgrounds. I know one LPN with a degree in English Lit who has actually printed off this CNEs emails and circled the errors in red and is saving them for use if the CNE rides over her again.

[Sarah010101]

Hahahaha... thats hilarious.

I am not bashing anyone... I am just a student, and yes I know some things, and I

do not know a lot of things... however when you threaten to write me up.. it makes

me assume that I did something wrong. So when nobody could answer my potassium

question at work I thought to bring it here... Which, it seems I was not wrong and the

only thing to work on is communication with the doctor.. which I know will come in

time. :)

And I recieved an email the other day about antihypertensives and how to determine

whether to give it or not. At first I thought the email was just for me, since an incident

occurred on the unit where a nurse held ramipril for a BP of 99/54... I think I would have too,

and then her BP shot up to like 165... I guess it was sent to everyone.. very unhappy

LPNs and RNs on our unit.

However I can say i HAVE learned vaulable information from the CNE... but it seems like

because I am the only ESN working on the unit and the nurses there have helped me out

SO much... the CNE is out to get me. lol.. guess it makes me work harder :)