Aa
Very High Potassium
Does anyone know what this means? What can cause it or lower it. Just came back from doctors. She seems very concerned about it. Took another blood sample to confirm it. It's 7.5
All she said was it wasn't anyhing I ate. And that it coud be a whole host of things. Can anyone help? Thanks
All she said was it wasn't anyhing I ate. And that it coud be a whole host of things. Can anyone help? Thanks
I am 49 and recently started a cholesterol reducing prescription (Baycol). After one month of use, my doctor requested some lab work. The lab work showed my potassium level to be over 200! The normal range, I'm told, is 3-4. They sited lab error and asked me to give another blood sample. The second sample had a normal level of potassium.
Baycol was removed from the market and my prescription was changed to Lipitor. I went back to get blood work again, and the potassium level was again over 200! My doctor sited lab error again and has requested another blood sample, which I'll give tomorrow.
I feel absolutely fine. In fact just two weeks ago I completed a week long backpacking vacation in the Cascade mountains. We carried 70 pound packs up very rugged mountain trails.
Is there any way that potassium levels greater than 200 could occur naturally? I've heard that Baycol causes muscle cells to break down. Would this cause higher potassium levels? Are these really lab errors? Should I be dead?
Baycol was removed from the market and my prescription was changed to Lipitor. I went back to get blood work again, and the potassium level was again over 200! My doctor sited lab error again and has requested another blood sample, which I'll give tomorrow.
I feel absolutely fine. In fact just two weeks ago I completed a week long backpacking vacation in the Cascade mountains. We carried 70 pound packs up very rugged mountain trails.
Is there any way that potassium levels greater than 200 could occur naturally? I've heard that Baycol causes muscle cells to break down. Would this cause higher potassium levels? Are these really lab errors? Should I be dead?
Thanks for info. Jus came back from docs today. Second tes showed a little lower. 6.5 (but I had cheated on diet and had coffee) My Tbilly was a little high and my CO2 was ever lower than before. (First time 67 now 37) She wants me yo test my Adrenal gland first. In your opinion, is this a was of isurance money or shoud I be taing another test to see if in fact it i the kidneys? I've suspected Kidney failure all along. (Did I mention I have Celiac also?) Took them 40 years to find that. Now I have to get a colonoscopy to find out how mch damage is done. She also said something about my body NOT absorbing ANY FAT. I weigh about 98 lbs and I forget to eat. (Because I got sick when I did) now on the new gluten free diet my appetie is a lttle better. But I ate just about anything I wanted too and never gained weight. When I manged to put a little o I'd lose it and more from diareah. (I appologized for the spelling)
Any input would br greatly appreciated. My motto is "I'm sick of being sick" Thanks Mittens
Any input would br greatly appreciated. My motto is "I'm sick of being sick" Thanks Mittens
<hi1><font color="RED"><b>Potassium: An Element of Life</hi1></font></b>
Potassium is a silvery-white, inorganic, metallic element--a substance that can not be separated into simpler substances by chemical means. Commonly called K, a symbolic name derived from the Periodic Table of the Elements, potassium is essential for the functioning of the healthy human body. Nutritionally, potassium is labeled a mineral, meaning it occurs naturally in our environment.
Once potassium dissociates into the body's fluids, it becomes a powerful electrolyte, or an ion capable of conducting electrical current and constituting a major force of fluid balance within the body. The healthy human body is composed of 47 - 77% fluid, depending on the age, sex or personal characteristics of the individual. Seventy percent of the body fluid is intracellular, and thirty percent is extracellular. The intracellular fluid holds approximately 98% of the total body potassium.
Functions of Potassium
Potassium performs multiple life preserving functions in the human body. This electrolyte assists with the regulation of intracellular osmoregulation, the conduction of nerve impulses, cellular growth and metabolism, and the proper functioning of skeletal, cardiac and smooth muscle. Osmoregulation is the process of cells maintaining fluid and electrolyte balance, assisting with the transfer of nutrients through cell membranes.
The body's balance of fluids is controlled by the reciprocal interchanges of potassium, the major intracellular cation, and sodium, the major extracellular cation. These cellular interchanges aid in maintaining blood pressure and in transmitting electrochemical impulses for proper muscle contraction, including the heartbeat. During muscular repolarization, sodium is shifted into the cells and potassium out of the cells; during depolarization, the reverse happens. The concentration ratio of intracellular potassium to extracellular sodium determines the effectiveness of nerve and muscle cells.
Though sodium is readily conserved by the body, there is no effective method for potassium conservation. Even when a potassium shortage exists, the kidneys continue to excrete it. Because the human body relies on potassium balance for a regularly contracting heart and a healthy nervous system, it is essential to strive for this electrolyte's balance.
Dietary sources of potassium
Under most circumstances, eating a healthy diet will obtain the necessary potassium. Food sources include vegetables, dairy foods, fish, fruit, legumes, and grains. Rich sources of potassium are found in apricots, cantaloupe, avocados, bananas, brewer's yeast, raisins, dates, prunes, yams, mushrooms, garlic, nuts, winter squash and black-strap molasses. Potassium may also be obtained from the following herbs: red clover, sage, catnip, hops, horsetail, nettle, plantain and skullcap. Caffeine and tobacco reduce the absorption of potassium. People at risk for insufficient potassium intake include alcoholics, drug addicts and crash dieters.
Potassium deficit
Hypokalemia is a potassium deficit, or plasma levels below 3.5 mEq/L (milliequivalent per liter). Low serum potassium levels may be reflected secondary to the electrolyte's shift to intracellular space or to it's being lost from the total body stores.
A variety of situations may cause potassium to be lost from the total body stores. Potassium is depleted during times of stress when the adrenal glands secrete increased levels of epinephrine, pulling potassium from the cells to then be excreted by the kidneys. Large volumes of urinary output or exorbitant perspiration may cause excessive potassium loss. Endocrine disorders such as Cushing's syndrome and hyperaldosteronism cause overproduction of corticosteroids, provoking sodium retention and potassium excretion. Potassium wasting diuretics and certain antibiotics may push a borderline hypokalemia to unsafe potassium levels. Vomiting, diarrhea, laxative abuse and ostomies may cause large losses of potassium--the gastrointestinal secretions are rich in potassium; for this reason, prolonged gastric suction depletes potassium reserves. Cellular trauma, whether through injury, surgery or burns, evoke damaged cells to release their potassium to extracellular fluid, giving rise to temporary elevated serum levels; this extracellular potassium is then excreted through the kidneys, causing depletion of the total body potassium.
Serum potassium levels may drop below 3.5 mEq/L when potassium shifts from the extracellular fluid to the intracellular fluid. This fluid shifting may be caused by elevated insulin levels, alkalosis, or periods of massive tissue repair. The most common incidence of fluid shifting caused by elevated insulin levels is in the treatment of diabetic ketoacidosis. While in the hyperglycemic phase, the potassium is pulled from the intracellular space to the serum and then excreted through the kidneys. The serum may indicate that potassium levels are elevated, though the stores are being lost with polyuria. When insulin is given to reduce the hyperglycemia, potassium returns to the intracellular space, reducing serum potassium to dangerous levels if no replacement is given.
Signs of potassium deficiency include: slow thought processes, abnormally dry skin, depression, reduced bowel sounds, anorexia, abdominal distension, edema, nervousness, irregular heartbeat, high cholesterol levels, muscular fatigue, growth impairment, headaches, proteinuria and glucose intolerance. Electrocardiograph changes accompanying hypokalemia are ST depression, flat T waves, U waves and dysrhythmias. The pulse will be fast, then slow. If digitalized, monitor for digitalis toxicity.
Recognition of the signs and symptoms of hypokalemia may detain a disaster. Discuss these indicators with people at risk for potassium depletion, and provide a list so they may refresh their memory as needed.
Case Example:
Peter Jones, a 56 year old postal worker, came into the community hospital emergency room complaining of "heart palpitations" after two days of a "stomach flu." Over the past two days, he had vomited once and had eight episodes of diarrhea. Currently, the vomiting and diarrhea had subsided, and he was able to retain oral hydration and nutrition. Along with a low grade temperature, he had a slight headache, generalized weakness and muscular cramping in the lower part of his legs. His EKG revealed sinus rhythm, ST depression, U waves and some rare premature ventricular contractions (PVCs).
Mr. Jones had a history of high blood pressure, for which his primary care physician had prescribed hydrochlorothiazide, a thiazide diuretic. After performing a complete physical assessment, a serum electrolyte profile was ordered, revealing a potassium of 3.1 mEq/L. Though there may be instances of test result error secondary to blood hemolysis, the ER physician knew this result was correct because of the patient's hypokalemic signs and symptoms, including EKG changes. She wrote for several doses of oral potassium chloride replacement to be given, and referred Mr. Jones to his primary care physician for reevaluation of his medications.
The nurse gave the prescribed KCL with a full glass of cool water and several crackers to reduce the risk of further irritating his stomach. She gave Mr. Jones a list of the common signs and symptoms of hypokalemia, and a list of food items high in potassium. She explained that the diarrhea and vomiting caused him to lose potassium, which was further complicated by the potassium lost through diuresis from the hydrochlorothiazide. After a 23 hour outpatient observation, Mr. Jones was discharged home with a 4.1 mEq/L serum potassium level.
Prescribed potassium replacement
When dietary potassium replacement is insufficient, oral and intravenous potassium will be prescribed. Oral replacements include potassium chloride, potassium bicarbonate and potassium gluconate. Never interchange these supplements without an order; they may deliver varying amounts of potassium. The liquid potassium should be slowly sipped to reduce gastrointestinal distress. Oral replacement is given with 6 - 8 oz. of cool fluid, or after eating a meal.
Intravenous potassium is prescribed when oral replacement is not possible or if the hypokalemia is life-threatening. When blood serum potassium levels are below 2 mEq/ml, the maximum infusion rate that will be prescribed is 40 mEq per hour; the maximum fluid concentration will be 40 mEq in 500cc. When blood serum levels are more than 2mEq/ml, the maximum infusion rate is 10 mEq per hour; with the maximum fluid concentration of 20 mEq per 500 cc. The maximum 24 hour dosage of intravenous potassium that may be prescribed is 200 - 400 mEq. Follow your hospital policy concerning potassium/fluid concentrations. Many hospitals have developed stricter policies to reduce the risk of injury to the patient.
When given intravenously, potassium causes a painful burning sensation along the vein into which it is infusing. The physician may order small amounts of lidocaine to be added to the potassium mixture to reverse post infusion phlebitis. A nursing intervention to reduce the patient's discomfort is to apply a cool cloth or ice pack to the area.
Intravenous potassium is NEVER given as an IV Push. It must be mixed in the specified amount of fluid and infused slowly with an electronic intravenous pump. A nurse or health care provider experienced in intravenous potassium replacement must closely supervise this therapy. When mixing potassium into fluid, shake it very well; potassium is heavier than the IV fluid and may accumulate in the bottom of the bag, causing a fatal bolus. Never allow your patient to leave your unit with a potassium bolus infusing. Either accompany the patient or disconnect the potassium infusion during transfer. The priority is your patient's life.
More than one fatality has occurred from potassium mishaps. Previously, potassium was kept in medication drawers, alongside patient's meds, including lasix, which had a similar container. Several nurses, including senior staff, have injected the potassium instead of the lasix, causing patient death. Currently, potassium is not being kept on nursing units, which has decreased the potential for this fatal error. The basic rights (person, drug, amount, route, time) of medication delivery must be performed no matter how busy your schedule. The moment you save may cause someone to lose their life, and you to lose your nursing license.
Potassium excess
Hyperkalemia is potassium excess, or plasma levels above 5.0 mEq/L. High serum potassium levels may develop secondary to the electrolyte's shift to extracellular space, and then be compounded by reduced renal function. A variety of disorders may cause hyperkalemia.
When the kidneys are not receiving adequate fluid delivery, as in hypovolemia and heart failure, potassium excretion will be reduced. Fluids and inotropics may be ordered to correct this situation. Acute tubular necrosis is permanent damage to kidney cells, requiring dialysis to remove excess potassium. During the early stages of renal disorder, the body may be able to excrete the excess potassium. However, dialysis will be prescribed for end stage renal failure to control hyperkalemia and maintain electrolyte balance.
Primary adrenal insufficiency, such as occurs in Addison's disease and AIDS, causes a deficiency in mineralocorticoids and/or glucocorticoids, resulting in hyperkalemia. Corticosteroids, fluids and electrolytes, including potassium, may be prescribed to correct the adrenal insufficiency. The patient teaching plan will include discussing the signs and symptoms of hyperkalemia, and the strategies for its prevention.
Additional causes of hyperkalemia include acidosis, insulin deficiency, and massive tissue damage, such as occur with crushing injuries, burns and hemolysis.
Pseudohyperkalemia is the occurrence of serum potassium laboratory test results being greater than the patient's true potassium level. Blood may hemolyze in the lab tube causing platelets and white blood cells to release potassium into the serum, reflecting a false hyperkalemia. Falsely elevated levels may also occur if the tourniquet is left on too long, or if the patient opens and closes the fist too much, releasing excess potassium from the muscles. In the event pseudohyperkalemia is suspected, the potassium blood test will be repeated.
Signs of hyperkalemia include abdominal muscle cramps, diarrhea, generalized weakness, skeletal muscle spasms, and overall, increased excitability of nerves and muscles. Higher levels of anxiety and irritability will exist. The EKG will reveal a prolonged PR, wide QRS, ST depression and tall T waves. The pulse will be slow and weak.
Discuss the basic signs and symptoms of hyperkalemia with those at risk. Provide a list so they may refresh their memory as needed. Recognition of the early signs and symptoms may promote a more timely treatment of its source.
Case Example:
Paul Smith, a 23 year old male with end stage renal failure, was brought to the emergency room by his tearful mother. He was scheduled for dialysis the previous day, but went out drinking with his friends, continuing late into the night. His friends brought him home to his mother when "something seemed wrong with him."
Paul was lethargic, confused and slightly combative. His respiration was slow and deep; lung sounds revealed crackles at the bases. Laboratory results indicated multiple electrolyte imbalances, including a potassium level of 7 mEq/L. His EKG was sinus rhythm with tall, peaked T waves, widened QRS complexes, low amplitude P waves, and frequent ventricular ectopy. The arterial blood gas revealed metabolic acidosis.
The physician ordered the combination of dextrose 50, insulin and sodium bicarbonate to be given intravenously in order to temporarily drive the potassium back into the cellular space. Kayexalate (sodium polystyrene sulfonate) was given via a nasogastric tube to remove excess potassium by binding it to an ion exchange resin in the intestines for fecal elimination. Paul's cardiac status was closely monitored until he was dialyzed, when his serum potassium was returned to a normal level, between 3.5 to 5 mEq/L.
Once Paul's medical condition was stabilized, he was diagnosed with depression and referred for psychiatric treatment.
**********
Persons with the potential for potassium imbalance require information about their disease process, the treatments they are receiving and the strategies they may implement to prevent electrolyte disorder. Discuss the necessity to have their potassium level measured at regular intervals. Provide a list of the signs and symptoms accompanying altered potassium levels. Also provide a list of potassium rich foods that may either be added to or deleted from the diet according to the person's needs. Though the majority of your patients may have normal potassium levels, avoid missing those who don't. Nurses are legally responsible to recognize and report altered potassium levels to their patient's physician. Though potassium is an important element of life, its imbalance may be an element of death.
Potassium is a silvery-white, inorganic, metallic element--a substance that can not be separated into simpler substances by chemical means. Commonly called K, a symbolic name derived from the Periodic Table of the Elements, potassium is essential for the functioning of the healthy human body. Nutritionally, potassium is labeled a mineral, meaning it occurs naturally in our environment.
Once potassium dissociates into the body's fluids, it becomes a powerful electrolyte, or an ion capable of conducting electrical current and constituting a major force of fluid balance within the body. The healthy human body is composed of 47 - 77% fluid, depending on the age, sex or personal characteristics of the individual. Seventy percent of the body fluid is intracellular, and thirty percent is extracellular. The intracellular fluid holds approximately 98% of the total body potassium.
Functions of Potassium
Potassium performs multiple life preserving functions in the human body. This electrolyte assists with the regulation of intracellular osmoregulation, the conduction of nerve impulses, cellular growth and metabolism, and the proper functioning of skeletal, cardiac and smooth muscle. Osmoregulation is the process of cells maintaining fluid and electrolyte balance, assisting with the transfer of nutrients through cell membranes.
The body's balance of fluids is controlled by the reciprocal interchanges of potassium, the major intracellular cation, and sodium, the major extracellular cation. These cellular interchanges aid in maintaining blood pressure and in transmitting electrochemical impulses for proper muscle contraction, including the heartbeat. During muscular repolarization, sodium is shifted into the cells and potassium out of the cells; during depolarization, the reverse happens. The concentration ratio of intracellular potassium to extracellular sodium determines the effectiveness of nerve and muscle cells.
Though sodium is readily conserved by the body, there is no effective method for potassium conservation. Even when a potassium shortage exists, the kidneys continue to excrete it. Because the human body relies on potassium balance for a regularly contracting heart and a healthy nervous system, it is essential to strive for this electrolyte's balance.
Dietary sources of potassium
Under most circumstances, eating a healthy diet will obtain the necessary potassium. Food sources include vegetables, dairy foods, fish, fruit, legumes, and grains. Rich sources of potassium are found in apricots, cantaloupe, avocados, bananas, brewer's yeast, raisins, dates, prunes, yams, mushrooms, garlic, nuts, winter squash and black-strap molasses. Potassium may also be obtained from the following herbs: red clover, sage, catnip, hops, horsetail, nettle, plantain and skullcap. Caffeine and tobacco reduce the absorption of potassium. People at risk for insufficient potassium intake include alcoholics, drug addicts and crash dieters.
Potassium deficit
Hypokalemia is a potassium deficit, or plasma levels below 3.5 mEq/L (milliequivalent per liter). Low serum potassium levels may be reflected secondary to the electrolyte's shift to intracellular space or to it's being lost from the total body stores.
A variety of situations may cause potassium to be lost from the total body stores. Potassium is depleted during times of stress when the adrenal glands secrete increased levels of epinephrine, pulling potassium from the cells to then be excreted by the kidneys. Large volumes of urinary output or exorbitant perspiration may cause excessive potassium loss. Endocrine disorders such as Cushing's syndrome and hyperaldosteronism cause overproduction of corticosteroids, provoking sodium retention and potassium excretion. Potassium wasting diuretics and certain antibiotics may push a borderline hypokalemia to unsafe potassium levels. Vomiting, diarrhea, laxative abuse and ostomies may cause large losses of potassium--the gastrointestinal secretions are rich in potassium; for this reason, prolonged gastric suction depletes potassium reserves. Cellular trauma, whether through injury, surgery or burns, evoke damaged cells to release their potassium to extracellular fluid, giving rise to temporary elevated serum levels; this extracellular potassium is then excreted through the kidneys, causing depletion of the total body potassium.
Serum potassium levels may drop below 3.5 mEq/L when potassium shifts from the extracellular fluid to the intracellular fluid. This fluid shifting may be caused by elevated insulin levels, alkalosis, or periods of massive tissue repair. The most common incidence of fluid shifting caused by elevated insulin levels is in the treatment of diabetic ketoacidosis. While in the hyperglycemic phase, the potassium is pulled from the intracellular space to the serum and then excreted through the kidneys. The serum may indicate that potassium levels are elevated, though the stores are being lost with polyuria. When insulin is given to reduce the hyperglycemia, potassium returns to the intracellular space, reducing serum potassium to dangerous levels if no replacement is given.
Signs of potassium deficiency include: slow thought processes, abnormally dry skin, depression, reduced bowel sounds, anorexia, abdominal distension, edema, nervousness, irregular heartbeat, high cholesterol levels, muscular fatigue, growth impairment, headaches, proteinuria and glucose intolerance. Electrocardiograph changes accompanying hypokalemia are ST depression, flat T waves, U waves and dysrhythmias. The pulse will be fast, then slow. If digitalized, monitor for digitalis toxicity.
Recognition of the signs and symptoms of hypokalemia may detain a disaster. Discuss these indicators with people at risk for potassium depletion, and provide a list so they may refresh their memory as needed.
Case Example:
Peter Jones, a 56 year old postal worker, came into the community hospital emergency room complaining of "heart palpitations" after two days of a "stomach flu." Over the past two days, he had vomited once and had eight episodes of diarrhea. Currently, the vomiting and diarrhea had subsided, and he was able to retain oral hydration and nutrition. Along with a low grade temperature, he had a slight headache, generalized weakness and muscular cramping in the lower part of his legs. His EKG revealed sinus rhythm, ST depression, U waves and some rare premature ventricular contractions (PVCs).
Mr. Jones had a history of high blood pressure, for which his primary care physician had prescribed hydrochlorothiazide, a thiazide diuretic. After performing a complete physical assessment, a serum electrolyte profile was ordered, revealing a potassium of 3.1 mEq/L. Though there may be instances of test result error secondary to blood hemolysis, the ER physician knew this result was correct because of the patient's hypokalemic signs and symptoms, including EKG changes. She wrote for several doses of oral potassium chloride replacement to be given, and referred Mr. Jones to his primary care physician for reevaluation of his medications.
The nurse gave the prescribed KCL with a full glass of cool water and several crackers to reduce the risk of further irritating his stomach. She gave Mr. Jones a list of the common signs and symptoms of hypokalemia, and a list of food items high in potassium. She explained that the diarrhea and vomiting caused him to lose potassium, which was further complicated by the potassium lost through diuresis from the hydrochlorothiazide. After a 23 hour outpatient observation, Mr. Jones was discharged home with a 4.1 mEq/L serum potassium level.
Prescribed potassium replacement
When dietary potassium replacement is insufficient, oral and intravenous potassium will be prescribed. Oral replacements include potassium chloride, potassium bicarbonate and potassium gluconate. Never interchange these supplements without an order; they may deliver varying amounts of potassium. The liquid potassium should be slowly sipped to reduce gastrointestinal distress. Oral replacement is given with 6 - 8 oz. of cool fluid, or after eating a meal.
Intravenous potassium is prescribed when oral replacement is not possible or if the hypokalemia is life-threatening. When blood serum potassium levels are below 2 mEq/ml, the maximum infusion rate that will be prescribed is 40 mEq per hour; the maximum fluid concentration will be 40 mEq in 500cc. When blood serum levels are more than 2mEq/ml, the maximum infusion rate is 10 mEq per hour; with the maximum fluid concentration of 20 mEq per 500 cc. The maximum 24 hour dosage of intravenous potassium that may be prescribed is 200 - 400 mEq. Follow your hospital policy concerning potassium/fluid concentrations. Many hospitals have developed stricter policies to reduce the risk of injury to the patient.
When given intravenously, potassium causes a painful burning sensation along the vein into which it is infusing. The physician may order small amounts of lidocaine to be added to the potassium mixture to reverse post infusion phlebitis. A nursing intervention to reduce the patient's discomfort is to apply a cool cloth or ice pack to the area.
Intravenous potassium is NEVER given as an IV Push. It must be mixed in the specified amount of fluid and infused slowly with an electronic intravenous pump. A nurse or health care provider experienced in intravenous potassium replacement must closely supervise this therapy. When mixing potassium into fluid, shake it very well; potassium is heavier than the IV fluid and may accumulate in the bottom of the bag, causing a fatal bolus. Never allow your patient to leave your unit with a potassium bolus infusing. Either accompany the patient or disconnect the potassium infusion during transfer. The priority is your patient's life.
More than one fatality has occurred from potassium mishaps. Previously, potassium was kept in medication drawers, alongside patient's meds, including lasix, which had a similar container. Several nurses, including senior staff, have injected the potassium instead of the lasix, causing patient death. Currently, potassium is not being kept on nursing units, which has decreased the potential for this fatal error. The basic rights (person, drug, amount, route, time) of medication delivery must be performed no matter how busy your schedule. The moment you save may cause someone to lose their life, and you to lose your nursing license.
Potassium excess
Hyperkalemia is potassium excess, or plasma levels above 5.0 mEq/L. High serum potassium levels may develop secondary to the electrolyte's shift to extracellular space, and then be compounded by reduced renal function. A variety of disorders may cause hyperkalemia.
When the kidneys are not receiving adequate fluid delivery, as in hypovolemia and heart failure, potassium excretion will be reduced. Fluids and inotropics may be ordered to correct this situation. Acute tubular necrosis is permanent damage to kidney cells, requiring dialysis to remove excess potassium. During the early stages of renal disorder, the body may be able to excrete the excess potassium. However, dialysis will be prescribed for end stage renal failure to control hyperkalemia and maintain electrolyte balance.
Primary adrenal insufficiency, such as occurs in Addison's disease and AIDS, causes a deficiency in mineralocorticoids and/or glucocorticoids, resulting in hyperkalemia. Corticosteroids, fluids and electrolytes, including potassium, may be prescribed to correct the adrenal insufficiency. The patient teaching plan will include discussing the signs and symptoms of hyperkalemia, and the strategies for its prevention.
Additional causes of hyperkalemia include acidosis, insulin deficiency, and massive tissue damage, such as occur with crushing injuries, burns and hemolysis.
Pseudohyperkalemia is the occurrence of serum potassium laboratory test results being greater than the patient's true potassium level. Blood may hemolyze in the lab tube causing platelets and white blood cells to release potassium into the serum, reflecting a false hyperkalemia. Falsely elevated levels may also occur if the tourniquet is left on too long, or if the patient opens and closes the fist too much, releasing excess potassium from the muscles. In the event pseudohyperkalemia is suspected, the potassium blood test will be repeated.
Signs of hyperkalemia include abdominal muscle cramps, diarrhea, generalized weakness, skeletal muscle spasms, and overall, increased excitability of nerves and muscles. Higher levels of anxiety and irritability will exist. The EKG will reveal a prolonged PR, wide QRS, ST depression and tall T waves. The pulse will be slow and weak.
Discuss the basic signs and symptoms of hyperkalemia with those at risk. Provide a list so they may refresh their memory as needed. Recognition of the early signs and symptoms may promote a more timely treatment of its source.
Case Example:
Paul Smith, a 23 year old male with end stage renal failure, was brought to the emergency room by his tearful mother. He was scheduled for dialysis the previous day, but went out drinking with his friends, continuing late into the night. His friends brought him home to his mother when "something seemed wrong with him."
Paul was lethargic, confused and slightly combative. His respiration was slow and deep; lung sounds revealed crackles at the bases. Laboratory results indicated multiple electrolyte imbalances, including a potassium level of 7 mEq/L. His EKG was sinus rhythm with tall, peaked T waves, widened QRS complexes, low amplitude P waves, and frequent ventricular ectopy. The arterial blood gas revealed metabolic acidosis.
The physician ordered the combination of dextrose 50, insulin and sodium bicarbonate to be given intravenously in order to temporarily drive the potassium back into the cellular space. Kayexalate (sodium polystyrene sulfonate) was given via a nasogastric tube to remove excess potassium by binding it to an ion exchange resin in the intestines for fecal elimination. Paul's cardiac status was closely monitored until he was dialyzed, when his serum potassium was returned to a normal level, between 3.5 to 5 mEq/L.
Once Paul's medical condition was stabilized, he was diagnosed with depression and referred for psychiatric treatment.
**********
Persons with the potential for potassium imbalance require information about their disease process, the treatments they are receiving and the strategies they may implement to prevent electrolyte disorder. Discuss the necessity to have their potassium level measured at regular intervals. Provide a list of the signs and symptoms accompanying altered potassium levels. Also provide a list of potassium rich foods that may either be added to or deleted from the diet according to the person's needs. Though the majority of your patients may have normal potassium levels, avoid missing those who don't. Nurses are legally responsible to recognize and report altered potassium levels to their patient's physician. Though potassium is an important element of life, its imbalance may be an element of death.
This is quite high in my opinion, and needs probably further evaluation. Potassium is a crucial electrolyte, because serum potassium has such a narrow range 3.5-5 meq/liter any slight deviation in either direction can produce profound consequences!!! At my hospital we would administer Kayexalate with 70 % sobitol for a KCL level like this. As a stated there is something going on here problem mostly Kidney of some sort, or possible excessive use of potassium-sparing diurectics, dehydration, possibly the development of Addisons., etc. I would advise further evaluation as a medical profession I am assuming your doctor is already taking care of this, I hope.
Dee RN,C CLTC
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