treating hemolyzed potassium level...

Specialties Emergency

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Specializes in Emergency, Telemetry, Transplant.

Dialysis pt has a K level come back at 5.7 (slightly hemolyzed). Since I wanted my make sure my other pt was not bleeding to death (another story!) and the doctor was not there, I would tell him when he came back. When I got back to my computer I see hyperkalemia orders (D50, insulin, Na bicarb). So I tell the doctor...the K was 5.7 but it was slightly hemolyzed..."do you want me to draw another one before I treat this?" His reply: "well, yeah, draw another one and send it, but they treat it. It will take over an hour for the result to come back so you might as well get starter treating it."

So I redraw the K and send it, they look to the orders for the specifics. Yes, he ordered D50, but he also ordered 10 units of regular IV. :eek: I was really busy anyway, so I did not draw up all her meds...waited for the repeat K to come back, and it was 4.9. He the cancelled all his hyperkalemia orders....

My questions:

1. What do you do with a hemolyzed K? Automatically redraw it? Base a treatment off it?

2. Would you have gone with the treat it approach or wait?

3. If the doctor insists on what you feel is a dangerous order, what do you do? What do you say to the doctor?

Thanks in advance for the responses....

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Specializes in Emergency, Internal Medicine, Sports Med.

If I feel like the order is dangerous, I question it. If I understand the rationale, I follow it. If I still disagree, I will hand everything over to the doc and say "then you do it" (I've done that once). Yup, you get rude mudders, comments, and put on their bad-nurse list..... but looking back I think some doctors respect it more, because it means you're thinking, and you're out to protect the patients and ultimately the doctor's a**.

We treat a K of 5.7 a lot less aggressively then that though, so I can't really compare.

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Specializes in Critical Care.

1. How long have you been a treat a nurse ? I don't care if the sample is 'slightly hemolyzed' you draw off a new sample, sorry but thats pretty dangerous to treat a incorrect number.

2. Hell no I wouldn't have treated it, like I said redraw and wait. 5.7 isn't THAT high. It's not gonna hurt someone to draw a stat CMP/BMP and and have the correct results.

3. If a doc insists on something that you feel is dangerous then hand him whatever meds it is and tell them to give it. Because if you do give it and something happens and you god forbid end up in court; remember this question "what would the prudent nurse do".

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Specializes in Telemetry, Oncology, Progressive Care.

Like 2 others have said it isn't that high. But, it isnt that high ESPECIALLY for a dialysis patient. Dialysis patients can handle fluctuations in their K levels much better than a non dialysis patient. Aside from the fact that it was hemolyzed. 1st was your patient in need of dialysis. If so, then HD will correct the high K. For that level I have NEVER gone the D50 and regular insulin route. They usually give kaexylate if they want it to some down. I don't usually see an order for D50 and reg insulin until their K >6.0.

Now to answer your question. Yes I would have it redrawn. Yes I would have waited until I got that sample back. I definitely would have talked to the doc about why he was being so aggressive about treating the K level. I've had docs order kaexylate 1 hour before a patient is supposed to get dialysis. Really? That is just plain cruel.

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Specializes in Nephrology, Cardiology, ER, ICU.

Dialysis pts with a K of 5.7 is normal. Does not need to be treated. However does need to be redrawn.

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Specializes in ER.

usually treat (even if slightly hemolyzed) then redraw in one hour.

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Specializes in Critical Care.

Why didn't he order it STAT so that it didn't take an hour to come back?!

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Specializes in Nephrology, Cardiology, ER, ICU.

But my point is that for a dialysis pt, a K of 5.7 is NORMAL - there is no reason to treat in this particular instance.

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Specializes in Critical Care.

Anything above 5.5 is considered too high on my floor (nephrology) for dialysis patients and the MD may want to order dialysis treatment depending on the patient. I would be concerned to call 5.7 "normal" in a HD pt. Maybe common, but not normal. This is just what I have seen on my floor, of course!

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1. How long have you been a treat a nurse ? I don't care if the sample is 'slightly hemolyzed' you draw off a new sample, sorry but thats pretty dangerous to treat a incorrect number.

Ooohh.....is it me or does this post smack of condescension? Who cares how long this person has been a nurse...there is a bona fide question being asked.

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Specializes in Emergency, Telemetry, Transplant.
1. How long have you been a treat a nurse ? I don't care if the sample is 'slightly hemolyzed' you draw off a new sample, sorry but thats pretty dangerous to treat a incorrect number.

I guess I should have been more specific in my OP. I was going to redraw it. I was clarifying with him whether he did or did not want my to treat the hemolyzed result. I was totally expecting him to say to wait until the repeat came back. When he told me to just go ahead and treat, that is when I noticed his exact orders and the relative danger involved in them....

P.S. what is a 'treat a nurse'?

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Specializes in Nephrology, Cardiology, ER, ICU.

I'm a nephrology APN and my nephrologists would laugh at me if I wanted to treat an HD pt who's K+ was 5.7.

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