PATPRN

Just a follow up on the patient. Yesterday (Saturday 1-12-08) afater Cardiologist saw her, she received a total of 5 runs of 10meq. Had a bedside echo done (EF 15%) global akensia. K= serum has never got above 3.2 throught the day yest and I admisisterd another run this morning prior to leaving. When I spoke to Cardiologist covering her last night wanting an update on her condition, I took the chance at a learning opportunity. I knew that a low Serum K+ can and will cause all sorts of CV difficulties. Cardio confirmed to me that I was right in administering the K+ run as ordered, and she said in all actuality if she would have been consulted prior to admit from the ER, she would have had them as an admitting order. My patient was admitted without any beta blockade, no Morphine for pain control, and not any of her home meds had been reordered through the Med Reconcil. When speaking to the family physician that admitted her throughout the night, I was sucessful in obtaining all the orders I needed. I have been a nure on Tele for 8 years and have done several shifts as swing in ICU. i can say that this was one case that made me loose precious sleep through the day yesterday dealing with my feelings and statement from superior nurse that by administering the K+ run, i extended her MI. I was especially calmed when I started last PM shift and found out all those runs she received were ordered through Cardiologist. Nursing is a continous learning experience. We learn from books, we learn from Doctors, patients. But,,,I know more than ever we also learn from our own hearts. Love to all that posted to me. I will keep you updated on her outcome, (although it seems quite gaurded at this time) but she was in "stable" condition when I left this am. Now its off to bed for I will pull another night and comfort her and her daughter as we attempt to pull her through this episode...........

The patient had a troponin I level of 0.039 upon admit with a 3.0K+level. 8 hour troponin I was 3.09, K+ level of 2.9. Physcian ordered 1/2 ns with 40K and a 10 meq run of K+ in addition to Metoporol 100mg p.o. 12 lead ECK showed minor ST elevation leads V2, V3, with ST depression lead II. IV K+ was stated at 100 mls per hour. 15 minutes into infusion, patient become flushed, diaphoretic, no c/o of chest pain. 12 obtained, showed major ST elevation most all leads. Senior nurse coming on at time of 12 lead analysis stated it was the IV potassium caused the extension of MI. Needless to say this has devestated me by her remark. She stated the K+ run should never have been administered.

Can administration of K+ 10mEq/100cc N/S (level 2.9) irritate myocardial muscle and cause extension of an MI?