treating hyperkalemia

[VAJenny]

please give me some insight on this..

when a patient has a high K, and the doc orders 10 units of insulin and 1 amp of d50.... i understand that the insulin pushes the K into the cells..but are we just giving the d50 to prevent hypoglycemia?.. also...does it matter which one goes first?

[getoverit, BSN, RN, EMT-P]

You ask good questions.

Yep, D50 is just to prevent hypoglycemia. the insulin is the active transport to move the k+ across the cell membrane. 10 units of R is a pretty good sized dose.

Sometimes we also use albuterol in conjuction with the insulin and d50. that also helps transport potassium.

[VAJenny]

does it matter if the insulin or d50 is given first?...

this pt was getting albuterol nebs too.. but i read somewhere that this can be given IV.. (crazy!..never heard of that).....

[getoverit, BSN, RN, EMT-P]

as long as the D50 and insulin are given at the same time, it doesn't matter which one goes in first.

[nuberianne_RN]

I had to treat a pt with Insulin and D50 recently and decided to push the D50 first. It is a good thing I did that because my pt's vein blew just as I started to push the D50. She was a very hard stick and I would have been up the creek if I had given her insulin first. Make sense? BTW I work in the ER so she only had one line at the time.

[KlamsterRN]

D50 is NOT GIVEN TO PREVENT HYPOGLYCEMIA!!!!!!!!!! People who do NOT know for a fact should stop misleading other nurses... It's not safe. Reference the 2013 update to this article: https://allnurses.com/emergency-nursing/hyperkalemia-order-meds-520208-page2.html

[KlamsterRN]

Also, insulin is NOT the transport to K into a cell! Insulin is the hormone that finds to a receptor to allow glucose (carbon, which is needed in glycolysis to make ATP) to enter the cell. The resultant ATP attaches to the NA/K pump which allows 3 sodium to exit the cell and 2 potassium to enter the cell. Please research just a tiny bit before posting opinions. This is what decreases your serum or extra cellular K. Also, glucose alone would draw potassium out of the cell, so giving d50 then the vein blowing will also harm your patient....

[ktliz]

Klamster, I'm not sure I follow your logic. Yes, that is the mechanism by which insulin reduces extracellular K, but you are forgetting that there is already glucose in the blood to facilitate that mechanism. Whether the body uses its own glucose or the glucose from the D50, the result on K is the same. However, if it uses up it's own glucose in the reaction, hypoglycemia will result as it won't be able to produce more glucose quickly enough.

In a DKA patient with hyperkalemia, you wouldn't give D50, because the patient has more than enough blood glucose. You just need insulin to draw that glucose into the cell to power the Na-K pump.