NurseT88

No mention of concurrent drug use - especially marijuana from the posts. Are any of your departments doing drug screens to assess for a drug related component? What I'm finding with the patients being seen in the departments I'm working in is all these patients are chronic marijuana users. We throw every anti-emetic at these patients, including Haldol, yet all that seems to ease the symptoms (other than a threat to use only non-parenteral approaches) is a narcotic - which miraculously works the second it is pushed like a switch has been thrown. Certainly leads one to identify these patients as seekers.

an online EM forum I found this, is anyone practicing this standard? : 10 units of regular insulin bolus, followed immediately by 50 mL of 50 percent dextrose (25 g of glucose) is inadequate! This regimen may provide a greater reduction in serum potassium since the potassium-lowering effect is greater at the higher insulin concentrations attained with bolus therapy. However, hypoglycemia occurs in up to 75 percent of patients treated with the bolus regimen, typically about one hour after the infusion. To avoid this complication, infuse 10 percent dextrose at 50 to 75 mL/hour or give 2 amps of D50 (50 grams) and ensure close monitoring of blood glucose levels.Update: One of the commenters below asked for a reference for the up to 75% statistic. Took some time to track it down, but it is this article (PMID: 2266671). This article showed a markedly lower, but still worrisome percentage in gen pop. Most of those events were with the 1 amp regimen (PMID 22489323). This one showed an incidence of 13% (doi: 10.1093/ckj/sfu026).

What is the standard way to give D50 for hyperkalemia? I'm not asking route, but the parenteral manual indicates IV direct is for emergency use only. Would you direct push the D50 for a potassium of 6.2? Or would you run an infusion? And if the option is to run an infusion - do you use a syringe pump? Or transfer the D50 into a minibag?