Treating elevated blood glucose - yay or nay?

[DayDreamin ER CRNP]

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?

[nurseprnRN, BSN, RN]

insulin + glucose drags along k+ from the extracellular (serum) place to the intracellular place, so you have to look at serum k+ before you go doing that so as to leave enough k+ in in the extracellular place.

glu of 212 is not what i want for myself or my patients, but in the infinite scheme of things it's not that bad-- there are people walking around in the streets with that, and worse. but if you go shoving somebody's serum k+ down much below 2.7 you can get into real trouble fast, as this makes the myocardial cells more likely to discharge without being told, this being where pvcs come from; multifocal pvcs are an invitation to vt and then vf, and you don't really want to do that. also, anybody c glucose of 212 is probably diabetic (not universally, but more than likely) so they may already have reasons to have a cranky myocardium. let us not provoke it.

get the k+ under control; watch the glucose for increases, but treat very, very carefully and only if they get up too high, which they will probably not do unless some fool gives her d50.

[RNChristy]

I also would not worry too much about treating that blood sugar right away because of the effect on the K+. When hanging IV K+, we also had Neut. that we could get an order for and mix in the bag. Otherwise, we would run the K+ at a slower rate. If that didn't work, when the patient is able to take PO, supplement with po K+ or add to IV fluids if still NPO (per orders of course).

Christy