Wouldn't you like to know...

[punkstar]

Scenario...

So today at work my preceptor told me to do some research about dialysis patients and why it is that they receive kayexalate po , insulin 10 U iv push , sodium bicarbonate iv push, and D50 iv push. She also mentions that there is a time frame as to when you can draw blood / start a line with the dialysis patient who has a right side mastectomy and a left arm av shunt.

Any help you can give me to critically think, I'd appreciate it.

[Lisa CCU RN, RN]

Well, the pt. gets dialysis because their kidneys aren't working effectively and the kidneys excrete K, so the kayexalate helps get rid of the excess potassium. I assume that the IV insulin is to drive some of the K back into the cells, I was told that this was done in cases of life threatening high levels. I would think that the D 50 is to cover for the low glucose levels after giving the insulin IV push. The bicarb, I am not sure, maybe dialysis patients tend to be acidotic?

That's my guess, hopefully someone with more knowledge comes along. I am still a student for now.

ETA: I think the bicarb is because the patient retains uric acid, which is acidic, so the bicarb neutralizes.

[Christie RN2006]

Well, the pt. gets dialysis because their kidneys aren't working effectively and the kidneys excrete K, so the kayexalate helps get rid of the excess potassium. I assume that the IV insulin is to drive some of the K back into the cells, I was told that this was done in cases of life threatening high levels. I would think that the D 50 is to cover for the low insulin levels after giving the insulin IV push. The bicarb, I am not sure, maybe dialysis patients tend to be acidotic?

That's my guess, hopefully someone with more knowledge comes along. I am still a student for now.

You are correct... dialysis patients tend to throw some high levels of K. They kayexalate helps them get rid of potassium through pooping it out. The insulin basically hides the potassium and the D50 is to cover for the low insulin levels. The dialysis also helps to pull the K out of their body. The insulin and D50 is only a short fix, so you have to do kayexalate and/or dialysis to correct the issue for more long term. I don't remember for sure about the bicarb... I remember hearing something about why you give it, but I can't remember exactly why.

[Cardiac-RN]

the bicarb forces the k+ from the extracellular fluid into the cells, lowering the serum potassium level and correcting the acidosis that was caused by too much extracellular k+.

[flightnurse2b, LPN]

Scenario...

So today at work my preceptor told me to do some research about dialysis patients and why it is that they receive kayexalate po , insulin 10 U iv push , sodium bicarbonate iv push, and D50 iv push. She also mentions that there is a time frame as to when you can draw blood / start a line with the dialysis patient who has a right side mastectomy and a left arm av shunt.

Any help you can give me to critically think, I'd appreciate it.

the sodium bicarb is the antidote to the acid that builds up in dialysis pts...and may also prevent hyperkalemia

the insulin is to counteract the dextrose in the dialysis solution, and the D50 to prevent hypoglycemia...OR to prevent hyperkalemia by giving insulin and then D50 to prevent hypoglycemia..

kayexalate is to send na to bind with the k+ to also prevent or treat hyperkalemia...

and about the blood draw.. im stumped at the moment