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. 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....