treating hemolyzed potassium level...


  • Specializes in Emergency, Telemetry, Transplant. Has 14 years experience.

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849 Posts

Specializes in Home Health.

I think any hemolyzed potassium lab need to be redone.


1,246 Posts

Has 36 years experience.

You said 'dialysis pt' but was the pt already in a treatment or was one scheduled in a short while? This would certainly make a difference in the treatment. And 5.7 may be within this particular pt's 'norm'.

No treatment without a redraw.


16 Posts

I would definitely wait for the labs to come back. I would also ask him to order the redraw as a stat. Problem solved. I would not treat on a questionable draw because who knows? Had k of 2.7 last week on my tele floor and had to redraw stat before starting k iv even though patient was starting to have frequent pvc's and pac's.

Esme12, ASN, BSN, RN

4 Articles; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 43 years experience.
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....end quote

My questions:

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

I would NOT treat a hemolyed specimen. I would do a STAT re-draw.

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

I would NOT treat........I would tell the MD I was not comfortable with treating a hemolysed specimen can I please wait for the re-draw.

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

If I still fell it dangerours and they insist on treatment. I politely explain why I feel uncomfortable and use a whole lot of sugar to get them to see my point of view! (you get more bees with honey). If they still insist.......I will still refuse.........and really take my time following them or just call my supervisor and my boss depending of the situation....... What do I say? I just say....NO!


82 Posts

I would redraw the specimen. :nurse:


70 Posts

Specializes in Cardiac, Thoracic, Vsg, ENT, GU. Has 21 years experience.

Redraw and let's just wait for the lab results, The hemolyzed wasn't all that high anyways. When you hit the 6 level that's is perhaps a little different but I'd still wait for the lab results.


91 Posts

Specializes in ED. Has 5 years experience.

I think you were prudent to wait for the redraw. We don't do the K cocktail unless the K is over 6. Esp in a dialysis patient.


547 Posts

Specializes in ED/trauma. Has 7 years experience.
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....

I'll probably repeat what others says, but it's probably worth reiterating.

When blood hemolyzes, K+ leaks from the cells, so it causes a falsely elevated K+. Other things cause a falsely elevated K+. That being said, I'd never treat an extreme chemistry without rechecking it first. If only 1 value is off, the entire chemistry is probably correct, but why take the chance? If the patient is asymptomatic, I'd much rather they wait. What happens if you drop their K+ too low? Why not make sure it's right the first time?

Your role as a nurse is to protect your patient. If you believe an order is dangerous, it is your responsibility to question it. If you don't understand something, ask a fellow nurse for clarification. When you work with good doctors, ask them too. Most will be happy to explain things to you. Ultimately, though, they can't force you to do anything. Just as you should know why you do certain things, you should also know why NOT to do certain things. Doctors are not gods. They do make mistakes. And it's our job to catch them.

My biggest concern with you story is that this was a dilaysis patient. The primary treatment for hyperkalemia in a dialysis patient is... dilaysis. If your doc was drawing off all that K+, then the patient dialyzes, they would end up hypokalemic. So that would have been something to ask him/her.

Good luck. Never stop questioning.