New ED nurse here, but not a new nurse & just looking for some insight..I have extensive ICU experience, and I have seen high potassium many, many, many times, upwards of 6 without symptoms, even upwards of 7 without symptoms...I never recall anyone getting too terribly excited for a potassium level between 5 - 6. I don't actually recall remembering anyone symptomatic with a K between 5 & 6
Twice now I have had patients with heart rates in the 40s, one was sinus brady on a fit 60 year-old, one was junctional-ish looking on a not-fit 80 year-old.
Both were A & O, stable on RA, BP WNL, no S/s of decreased perfusion. One came in for back pain, the other with throat "tightness". Not overt cardiac symptoms, but definitely could be considered atypical if it were cardiac-related...
Both Ks were 5.5-5.7 (iStats & serum) - mild hyperkalemia
On both cases, the docs were really worked up and like, "we need to do Calcium gluc, insulin and dextrose NOW for the hyperkalemia + albuterol." I was thinking, "ok you're really excited, and I've only ever done this during codes, and never saw anyone get this excited, but ok sure why not let's do this."
I realize that people different thresholds for symptoms r/t potassium
Both times, gave all those meds, heart rate/rhythm didn't change, not one bit. K verified to be down to 5.1 for one patient, and below 5 for the other. All other labs normal, except for Cr of 1.7 on the 80 year old (there was that person's cause of high K).
Anyway, is this normal to do this protocol all the time? Is this just part of how you rule out causes of bradycardias? The fit 60 year old could have been living in the 40s & the 80 year old was on a beta-blocker...Anyway, a nurse told me she saw someone arrest with a K of 5.5 - does that really happen, or was there possibly another cause for the code vs. a K of 5.5 that was not known, and perhaps a cause there would never be an answer for?
Also can CKD patients tolerate higher potassium levels because they are chronically elevated?