CLINICAL TIPS FOR NEW NURSES: MANAGING HYPERKALEMIA

One of my most popular clinical lectures is the one I do on fluid and electrolytes. You see fluid and electrolytes plays a role in EVERYTHING yet we often don’t spend a lot of time trying to understand them. And, I typically find that even experienced nurses truly don’t understand them.

So, I’ll be sharing some tips related to fluid and electrolytes that I believe EVERY new nurse needs to master to successfully care for patients. Because Potassium is one of the most “dangerous” electrolytes (we use potassium in “lethal injections”), we’re starting here.

I’ve already blogged about managing hyperkalemia using glucose and insulin. So if you haven’t read that one yet, check it out by clicking here.

Did you know these facts about Potassium?

Fact: Potassium acts as an irritant at the neuromuscular junction. The more potassium you have, the more irritated your cells get. We really worry about this when it comes to myocardial function. The heart gets irritated when the potassium level is high which can lead to ventricular arrhythmias (badness)!

Fact: You have way more potassium INSIDE the cell than OUTSIDE the cell. Some things can cause the potassium inside the cell to leak outside the cell. Things such as:

·      Acidosis – potassium LOVES to hang out in an acidotic environment. So when the pH of the blood drops, the potassium INSIDE the cell thinks there's a party happening OUTSIDE the cell and leaves leading to hyperkalemia.

·      Cell wall destruction – when you damage the cell wall through trauma, phlebotomy, etc. the cells will leak out their potassium leading to hyperkalemia.

Also, potassium is excreted through the kidneys. If your patient is in renal failure, potassium can’t be excreted and therefore, accumulates.

Fact: The treatments for hyperkalemia fall into 3 categories:

·      Get rid of it

·      Hide it

·      Counteract the effects of it

Giving glucose and insulin just hides the potassium. So does giving bicarbonate (I’ll write a blog post about this treatment soon).

Let's talk about getting rid of potassium. If you really want to get rid of potassium, you have two choices:

1.    Dialyze the patient – Love this option!!! But, it’s not always practical.

2.    Give Kayexelate – binds to potassium and is excreted in the feces (in an explosive way!). However, many nurses don’t know that to give Kayexelate the patient needs to have a functioning intestinal tract. If your patient has an ileus, Kayexelate won’t work. You could give as a retention enema though...just depends.

Bottom line: Potassium is an electrolyte you want to take seriously. Understanding what causes hyperkalemia and the various methods of treating can mean the difference between your patient recovering and going home and your patient leaving in a hearse!

Stay tuned for more regarding potassium and her other eletrolyte friends such as sodium, magnesium and calcium!

Thanks for choosing to become a nurse. I’m cheering for your success!!

Renee

To get a copy of my eBook titled, "Survive and Thrive: A guide helping new nurses succeed", click here!