Why didn't K decrease?

[CFrancine, BSN, RN]

I work in acutes. Patient had a K of 5.9 over night so the floor treated it. I drew a recheck level at the very start of the treatment, just to be sure the bath was appropriate for the new level. K was 5.1 so we did a 2k bath over 4 hour treatment, BFR 400. A couple hours post tx, the K was drawn again and it was 5.0. I drew a pre and post BUN with the treatment and the urea reduction rate was about 60%. So the patient had a good treatment. But why didn't the K go down?

[Twinmom06, ASN, APN]

was it a catheter patient or an internal access? If it was internal, perhaps a bit of recirculation? Also what was their blood sugar? If BS was high, K would remain high sometimes.

[Chisca, RN]

What is the patient's primary reason for being in the hospital?

[Chisca, RN]

I guess I'm looking for any reason the patient might be acidotic causing a release of potassium from the cells into the blood stream. As the dialysis treatment removed the extracellular potassium from the serum once the treatment ended there was an influx from the tissue back into the serum. Sometimes the EKG will correlate with the lab value with tall, tented T waves but that's not always the case. Insulin/glucose calcium are temporary measures that don't change the amount of potassium in the body. I'm guessing this patient required daily dialysis until the underlying cause was corrected.

.

[CFrancine, BSN, RN]

I don't remember exactly why the patient was in the hospital but I think it had to do with missing dialysis... His blood sugar was 40 when I started the treatment (because they gave him insulin to bring down his K). So we gave an amp of D50. So are you saying when they "correct" the K level, outside of Kayexalate, all they're really doing is making the potassium go in the cells? And After the treatment, the K went back into the blood, in attempts to balance things out again. So if they hadn't treated it, I might have seen more of a decrease in the value? That makes sense!