Potassium question...

[Soflo_RN]

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??

[Tait, MSN, RN]

Tell him to write an order for staff to call with a K of less than 3.5...even at 3am!

[turnforthenurse, MSN, NP]

K is important for all of the reasons listed above...but I would not call a K of 3.4 critical. I have however, seen patients with nearly non-existent (flattened) T waves with a K of 3.4, but some PO or IV K replacement will fix the problem.

At my facility, we have protocols for K, Phos & Mg. If the K level is 3.8 or below, we initiate replacement - even though a K of 3.8 is considered normal. I work on a cardiac floor so K is a very important lab to monitor. We start K replacement either PO or IV (depending on the protocol) and then order a lab draw for K 2 hours after the replacement to check the level. We can do this twice; if the lyte level is still "within replacing limits" or low, we need to call the doc to see what they want us to do. Most of the time they will just tell us to replace it again.

Not every patient is on replacement protocols; some physicians at our hospital do not like to use them for whatever reason. If I notice the K is low, I will call the physician and ask them what they want to do - usually they will just order a one-time replacement.

[NurseMaricel]

That's what I was thinking for 3.4, check what it was yesterday... if there's a sudden drop what was he/she on to cause the drop? Is it a renal pt? But over all there's no rush. It is not critically low.

[Crush]

Doctor overreacted. While K+ is important 3.4 is not critical. Your cath patient took priority at the time.