Potassium question...

OCNRN63, RN · Oct 16, 2011

Did you ever call about the K+, or did the doc come in while you were getting the other pt ready for the cath lab?

Soflo_RN · Oct 16, 2011

I was still getting the patient ready...I had every intention to call! I was in the room getting the patient ready when the doctor told the other patient her K was critically low and could not participate in physical therapy.

But I was going to call!

BacktoBasics · Oct 16, 2011

I think he was a bit overreacting because of the point during the day. The labs were drawn at 0600 and they were probably just resulted around change of shift. That K level is not “critical” (unlike what the physician believes) therefore you’re not stuck to the 30 min reporting by The Joint Commission. I can see how their K level could potentially cause problems but unless the patient was scheduled for PT at 0730 in the morning, then I think the Doc just needs to relax for a min. There’s still time to replace prior to PT. Typically where I work (in the ICU), unless critical labs are present we alert our physicians at AM rounds (they can start anywhere from 0800-1000).

DennRN · Oct 16, 2011

Potassium is an electrolyte that is partially responsible for the conduction of nerve impulses through the exchange of sodium and potassium across the cell membrane.

In other words, while some of the most extreme results of a potassium imbalance are heart related, this is because the heart is an organ that is controlled by electrical charges. Every muscle in the body is controlled by these charges as is the brain itself. Remembering the role of potassium in electrical conduction will help you to remember that imbalances will effect muscles and the CNS, I could give you a laundry list of all the signs and symptoms, but that's what a text book is for. I think that linking it all to conduction is the best way to jog your memory for next time.

Potassium also plays a role in acid-base and balancing water within the body, along with being a player in the building of proteins.

I hope this helps.

-Dennis

Epona · Oct 16, 2011

Potassium level is extremely important. The cardiac muscle is very susceptible to changes in K levels. Even a slight drop can irritate the heart and cause arrhythmias. My thought, before I started getting the pt ready, I would have called. Just know, K is something you need to critically monitor. Good luck!! :)

Esme12, ASN, BSN, RN · Oct 16, 2011

I had a patient the other day who had a potassium level of 3.4 (our lower K+ level is 3.6) and I did not call the doctor right away because I was getting a patient ready to go to the cath lab in 10 mins. The doctor came in at about 730 in the morning and said he couldn't believe no one called about this. (labs were drawn at 600). He also told the patient she could not participate in physical therapy until her potassium was stable and that it was critically low. The patient came in for chest pain but did not have a cardiac history. Did I have my priorities wrong and what exactly does low or high potassium cause, is it just arrhythmias??

Potassium is a critical lab to monitor in patients for both high and lows can cause arrythmias, muscle spasms, seizure and death.....and is vital to cardiac function as well as the balance of fluids and electrolytes in the body.

hyperkalemia........http://tinyurl.com/3dmg9xo

hypokalemia.........http://tinyurl.com/3d9etzy

although 3.4 is usually not a critical value usually.......the actual "critical" is determined by policy at your facility.

Here is a common list of critical values......http://depts.washington.edu/labweb/test/panic.html

Roxyann57 · Oct 16, 2011

whenever labs are endorsed to me or i receive them i always call right away. especially with potassium. it was low, doesn't matter if it's 0.2 below what is normal range. thats just me though.

Orange Tree · Oct 16, 2011

I can't imagine rushing to call anyone about a 3.4 potassium level.

Circejane · Oct 16, 2011

Our docs would not be happy to be paged at 6am with a 3.4 K+ level. And that is NOT critical. Some P.O. potassium would bring it up quickly.

Was the patient symptomatic? If not, sounds like the doc was overreacting. Unless your hospital policy is to notify docs stat of ANY abnormal labs, you acted appropriately.

ZippyGBR, BSN, RN · Oct 16, 2011

Our docs would not be happy to be paged at 6am with a 3.4 K+ level. And that is NOT critical. Some P.O. potassium would bring it up quickly.
Was the patient symptomatic? If not, sounds like the doc was overreacting. Unless your hospital policy is to notify docs stat of ANY abnormal labs, you acted appropriately.

probably not even oral K+ just a stat banana !

aCRNAhopeful · Oct 16, 2011

He was overreacting and I would only call for something like that in rare instances like pt needs IV lasix now and no orders for K replacement or some other situation that I was afraid of the K level dropping further fast. I would definitely take it seriously in a fresh open heart patient but in those cases there are usually orders for replacement already. Don't worry about it what so ever.