Potassium question...

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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??

Specializes in Cath Lab/ ICU.

I would not have called. the cath pt takes priority. I would have mentioned it when I saw the whites of the Drs eyes. A K+=3.4? meh...

This is when electrolyte replacement protocols are helpful. No need to bother anybody about minor lab values.

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Specializes in Emergency & Trauma/Adult ICU.

I once had an ER patient, in his mid-80s, who had seen his PCP for an annual physical earlier in the week and had labs drawn. His K+ also resulted at 3.4. This alert, oriented, active patient in overall excellent health for his age and without significant cardiac history told me that the PCP's office called him at home with instructions to "immediately go to the ER as his heart was at significant risk". :rolleyes:

I might have been inclined to think that he had misinterpreted the phone call, except that the staff in the PCP's office also called us to tell us of his imminent arrival, and that "he had refused their offer of arranging ambulance transport" to the ER for the K+ of 3.4.

EKG, venipuncture to recheck labs, 40mEq of KDur p.o., out the door.

How do you tell a patient who has had a PCP for 30 years, "your PCP is an idiot" ??

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A K+ of 3.4 is NOT a critical lab value.

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Ha ha ha... I love this: "A STAT Banana!"

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Specializes in I/DD.

I agree, you acted appropriately. Or at least that is what I would have done. Were you the oncoming shift or just leaving? If I was coming on I would feel proud of myself for having a pt ready for the cath lab at 0730...I am usually just finishing report. At my hospital patient transport is on a pretty strict time schedule. If they have to wait longer than 5-10 minutes for the patient to be ready they are required to call their supervisor and rearrange a time to get the patient. I usually refuse to let them leave, but I don't want to risk getting a stubborn one ;) For one thing, I am sure it didn't even result until ~0700, and a K=3.4 is not going to imminently cause an arrhythmia (maybe a couple PVC's). While I would tell the doc as soon as I physically saw him, it isn't something I would interrupt rounds for.

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Specializes in Telemetry RN.

3.4 not a critical level, but our cardiologists like pts on monitored units to keep K+ above 4 and mag above 2, so we bolus pt with non-critical levels frequently. They do expect the on call cardiologist to be notified of a "low" level when results are available; for the most part they are all on the same page about this, and that's why the is always someone on call. Labs results start coming in prior to change of shift on our unit, so i usually will make those calls around 6-630a. But that's our unit's culture, even on other floors in the hospital I'm sure this isn't the same. It's just one of those things you pick up on after working the same unit for awhile. Now you know that doctor's preferences for the future.

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Specializes in Psych ICU, addictions.

You handled it as I would have. 3.4 is not the end of the world: while the doctor did need to know about it promptly since you really can't mess with K+ levels, it was not worth dropping the cath patient to do it. It could have waited until afterwards...and in the meanwhile, I would have arranged for the patient to get some OJ.

Though in the future I'd call this doctor ASAP with any abnormal value, since that appears to be what they want.

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Specializes in LTC, Med-Surge, Ortho.

I am missing something. Since when did 3.4 become critical ?

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Specializes in CVICU.
I am missing something. Since when did 3.4 become critical ?

I dont know I'm surprised that there's people that would actually go out of their way for this. I wouldn't worry about it unless there was some unusual reason that it caused concern. Just take note of it and make sure the proper orders/treatment plan in place to prevent it from becoming an issue.

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Specializes in Endoscopy/MICU/SICU.
I dont know I'm surprised that there's people that would actually go out of their way for this. I wouldn't worry about it unless there was some unusual reason that it caused concern. Just take note of it and make sure the proper orders/treatment plan in place to prevent it from becoming an issue.

I agree, wouldn't usually call on this unless the pt had a significant cardiac hx. I'd just wait for the doc to round in the am and make sure some PO K+ was ordered.

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The anesthesia docs at our hospital would be alarmed about a 3.4, but the renal docs would be happy. Just have to know tour population sometimes.

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Specializes in Emergency/Cath Lab.

3.4 really? Nothing to see here move along. What would they order? 20 PO K+ then recheck the next morning. That is no big deal at all.

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