Serum potassium levels in code situation

[eaetaylor]

So I'm coding a patient that has had an acute MI, is in renal failure and currently has an ejection fraction of 10%. She had just been through a code no more than 1.5 hours ago, and when blood work was done in the first code, her serum potassium was 5.2. When we coded her again, another doc responded to the code and requested another serum potassium level. This one came back at 7.2. He stated that was her problem (even though this was the SECOND time we coded her). Is it possible that her serum potassium was only elevated due to her being down so long in the last code (40 minutes) that her RBCs began to catabolize, in addition to her decreased kidney function?

I guess my question is: Could the potassium level have been the RESULT of the code and not the cause?

[OptimusPrime]

Yes, the high potassium could have been a result of the code. Acidotic environments tend to draw K+ out of the cell and lead to hyperkalemia, and Im sure this pt was acidotic. Also, the sample may have been hemolyzed, but if that was the case, the lab should have called you or reported it.

[ghillbert, MSN, NP]

Did she get CPR the first time? CPR in and of itself can cause hemolysis and elevated serum potassium.

[eaetaylor]

Yes, she did get CPR the first time. Thanks for your input, that helps!

[ghillbert, MSN, NP]

You're welcome. It's a reason that it's difficult to detect potassium overdose: once someone arrests and receives CPR, the muscle damage will lead to hyperkalemia by itself.

[Cathlabnurse46]

The first question is "is it hemolysed". Repeat it or do an I-STAT durring the code or after wards and correct it. We use to correct high K+ levels durring codes with an amp of D50 and 100 units of insulin. The insulin draws the K+ back intra-cellular. Then give sorbatol (Kexalate). A good Dx tool is the ECG tracing. If the T waves are also peaked this would help to verify that the result is likely accurate.

[Dinith88]

So I'm coding a patient that has had an acute MI, is in renal failure and currently has an ejection fraction of 10%. She had just been through a code no more than 1.5 hours ago, and when blood work was done in the first code, her serum potassium was 5.2. When we coded her again, another doc responded to the code and requested another serum potassium level. This one came back at 7.2. He stated that was her problem (even though this was the SECOND time we coded her). Is it possible that her serum potassium was only elevated due to her being down so long in the last code (40 minutes) that her RBCs began to catabolize, in addition to her decreased kidney function?

I guess my question is: Could the potassium level have been the RESULT of the code and not the cause?

Yes (like everyone else said...for all those reasons) But...the K could have been a RESULT of the 1st and the CAUSE of the second code. Maybe what the doc meant...

[Dinith88]

The first question is "is it hemolysed". Repeat it or do an I-STAT durring the code or after wards and correct it. We use to correct high K+ levels durring codes with an amp of D50 and 100 units of insulin. The insulin draws the K+ back intra-cellular. Then give sorbatol (Kexalate). A good Dx tool is the ECG tracing. If the T waves are also peaked this would help to verify that the result is likely accurate.

Kayexalate (did i spell that wrong?) would be a poor choice in a code. A btter choice would be Calcium IVP. (along with your insulin/dextrose recipe...though 100 units may be a typo)

[Cathlabnurse46]

Kayexalate (did i spell that wrong?) would be a poor choice in a code. A btter choice would be Calcium IVP. (along with your insulin/dextrose recipe...though 100 units may be a typo)

10 units R was what we routinly gave. It took a lot of insulin to draw the K+ back into the cell. We could alway correct the low BS with dextrose. The potassium was a much more difficult problem. Sorbatol was never given in a code.... only in chronic pts or afterwards.