Treating elevated blood glucose - yay or nay?

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Specializes in ED.

Scenario: ER patient c/o severe abdominal pain. MD orders patient NPO d/t nausea and vomiting, etc. Pt is diabetic with BS of 212. Pt's K+ is 2.7. Pt was given IV k+ but later refused because it burned at the site.

Pt is later admitted to floor. Should the ER treat the 212 blood glucose before sending patient up to floor? Should the pt's K+ be retested?

What are your thoughts?

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Specializes in Critical Care.

I definitely would not treat a BG of 212 with a K+ of 2.7 (that will only lower the serum K+ even more). Pt's K+ should be rechecked following the IV K+ replacement after waiting for it to equalize. Particularly if they're refusing it by peripheral IV, a PICC or central line should be considered which is quicker in the ER. 2.7 is a little low to be just doing PO potassium replacement.

If they're going to a tele floor it would be nice to at least see 40meq or more at least started, if they're not going to a tele floor then the K+ needs to be at least 3.5 before you send them.

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I wouldn't expect the ER to treat it...but I'd expect to have ac/hs & prn accucheks ordered. What's in the IV? w/NPO, I can understand some d5, but if the N/V is d/t some sort of infection, the sugars could really get high in short order. I'm diabetic, and on 3 oral chemo meds that make my sugars just plain nuts...no matter what I eat, don't eat, etc. If I get an infection, they go over 300 in a couple of hours. With shingles they went up. If I were at home, I would treat a 212mg/dl- even at hs. But diabetics are all so different....I didn't realize how much until I started insulin. When I worked, we had such nice sliding scales- not real life :)

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Specializes in Medical Surgical Orthopedic.

My thoughts are: please do not bottom out the patient's blood sugar before sending them up to me :)

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Specializes in Med/Surg.

IMO, a blood sugar of 212 is not critical. A K+ of 2.7 would take priority over that. The intent of the ER is to stabilize the patient (and if they're being admitted, to BEGIN the process of stabilization). There is no reason the blood sugar can't be addressed when they get to the floor. You're going to need orders for ongoing accuchecks and insulin, so why get a one time order and have to do it all over again? A lot of times, at least where I worked, the doc admitting the patient wouldn't write orders until the patient got to the floor. Once they're there, you can get an order for a sliding scale, recheck the blood sugar (to make sure it hasn't changed greatly since the check in the ER) and give the first sliding scale dose.

It also wouldn't have served much purpose to recheck the K+ in the ER either (I'm not sure if that's what you meant by rechecking it; that's how it sounded). Until the patient gets the ordered dose, there's not much point. They need time to get the dose, and have it take effect. It should be rechecked later on, though.

If the patient was refusing the IV K+ due to burning, that can be remedied (or attempted to be). Putting a cool compress on the site, getting an order to add lidocaine to the mini bag, and infusing it at a slower rate all will help with the burning/discomfort of the K+ infusion. Any recheck of the serum K+ level wouldn't need to be done for probably several hours.

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I agree with Cherrybreeze. A BG of 212 is not critical, elevated but not critical. I just had a pt come to our unit with a BG of 1500- THAT"S critical!! K+ of 2.7 should definitely be treated because you want to avoid any cardiac dysrhythmias. As for K+ through an IV site- the MD should be aware that it will be infused through an IV and they should wirte an order for K+ c lidocaine.

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Specializes in Emergency/Cath Lab.

Id rather my sugars be high than low when I get them. Pot that low should def. be rechecked!

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Nay. CBG of 212 is not critical, and treating it with insulin will further drive down the K+.

A K+ of 2.7 is considered moderate, and these patients are often asymptomatic. PO replacement is appropriate for moderate hypokalemia. Getting the patient's nausea under control and administering a PO dose, then rechecking the serum potassium, would be a reasonable course.

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Specializes in Geriatrics, Transplant, Education.

The K should absolutely be checked, after the replacement has been given and has had time to take effect. I wouldn't panic about a glucose of 212, that can be handled when the patient gets to the floor.

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Specializes in Emergency Department.

Not a nurse yet, but I'm not going to get that upset at a BGL of 212. I'd be more concerned about the K+ of 2.7 as driving the K+ down by treating the BGL will kill the patient long before the BGL becomes an immediate problem.

Get the K+ up via whatever method the patient will allow and once that's stabilized, then go after the BGL and keep an eye on the K+...

At least that's my thoughts at this point. Further education probably would lead me right back to this though.

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Specializes in Acute Rehab, Med/surg Pediactrics.

I totally agree with Cherry breeze Yes If the patient was refusing the IV K+ due to burning, that can be remedied (or attempted to be). Putting a cool compress on the site, getting an order to add lidocaine to the mini bag, and infusing it at a slower rate all will help with the burning/discomfort of the K+ infusion. Any recheck of the serum K+ level wouldn't need to be done for probably several hours.

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Specializes in Critical Care, Cardiology, Hematology,.

forget the bg. im an the icu and can handle any bg you give me. but i got a transfer from the floor one time at 1330 with a k result at 0700 of 2.3 that hadnt been tx, i was upset. get a cent. line, give it po, or run it in over 6hr while being diluted with ns in a differant pump.

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