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nbme k+ - studyboy
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02-03-2006, 04:15 PM
This was a good one, pt with high potassium, like 6.9, with renal failure. Dialysis is set to start in 45 min. What to do next?
A)Supprt pt, until dialysis B)Ca Gluconate C)Bicarb D)Insulin + Glucose E)Kayexelate
02-03-2006, 04:22 PM
Yes, april 1st thing is IV Calcium gluconate(it's cardioprotective), then IV insluling followed by glucose, then B-agonist (albuterol intranasal). These are cardioprotective and move K+ in cells for the short fix, then dialysis and loops to remove K+ from body.
Does anyone know when we use Kayexelate?
02-03-2006, 05:28 PM
kayexalate is used when we want to remove k+ from body.
why can't it be bicarb. in this q? iv ca. gluconate is given only if ekg changes are + and also since the onset of action is very soon. also.... acidosis is an indication for dialysis.... so why can't it be bicarb.? please clarify.....
02-03-2006, 05:45 PM
For people on daily nocturnal hemodialysis who usually have to relearn to eat normally after years of being restricted, nephrologists will sometimes prescribe kayexelate to use on the off days or if a treatment has to be missed, so they don't have to worry about restricting their diet at those times.
NaHco3 has been controversal. I know for renal failure pts, usually elderly and those with previous cardiac conditions, you want to 1st use ca gluc. to protect the heart, followed by the others. If pt is younger and K+ is only say 5.9, u can use kayexelate(takes hours) and loops. Dialysis is only need for high or refractory cases and in those with renal failure.
02-03-2006, 05:46 PM
Sodium polystyrene sulfonate=Kayexalate: a cation exchange resin used in treating hyperkalemia.
Sodium polystyrene sulfonate is a cation exchange resin used in the treatment of nonlife-threatening hyperkalemia. Administered orally or rectally, the resin can effectively reduce serum potassium concentrations in the neonate as well as the elderly. Proper administration, assessment of drug effectiveness, and detection and prevention of potential adverse side effects of sodium polystyrene sulfonate are the responsibility of the nephrology nurse. PMID: 8431031 [PubMed - indexed for MEDLINE]
02-03-2006, 05:48 PM
"Nonlife-threatening..." So i guess, we just use it after pt's stable w all Ca, Insulin, BB...
02-03-2006, 06:04 PM
Hi CS,
NaHCO3 IV can be used to shift K+ into cells, often mixed w. Dextrose. .. Should be reserved for severe hyperK+ ass. w. metabolic acidosis. Pt w end-stage renal dz seldom respond to this intervention & may not tolerate the Na+ load & resultant volume expansion.p54 Parenteral NaHCO3 : caution b/c risk of Pul edema, hypokalemia, & Hypocalcemia. p59 ( Washington.29th edition) |
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