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.

CLINICAL TIP FOR NURSES: WHO WINS? GLUCOSE OR INSULIN?

Is it the glucose or the insulin??

When I teach clinical seminars, I always, always talk about fluid and electrolytes. One of my favorite things to talk about is potassium. In particular, how we treat hypo and hyperkalemia. In the next few blog posts, I'm going to map out some of the most common treatments for hyperkalemia - starting with glucose and insulin.

One thing you need to understand about potassium is that you have WAY MORE potassium INSIDE (145 mEq/L) the cell than you do OUTSIDE (3.5-5 mEq/L) the cell. So, any time you damage the cell wall or change the pH of the blood (will discuss that in a future blog post), the potassium INSIDE the cell will leak out into the extracellular space (blood vessel). 

Knowing that hyperkalemia can wreak havoc on the heart and other muscles, it's important to get the potassium back into the cell where it belongs!!!

TIP FOR NEW NURSES: HYPERKALEMIA: UNDERSTANDING TREATMENT OPTIONS

Potassium acts as an irritant at the neuromuscular junction. Too much and your cells get irritated; not enough and your cells get sluggish. Your heart demands a normal potassium level for its electrical conduction system to work. Too much and you’ll see a peaked T wave; too little and you’ll see ventricular arrhythmias! So, hyperkalemia is a bad thing for your patient’s heart and needs to be treated immediately!

There are so many different ways to treat hyperkalemia, but how do you know what treatment is best and in which situation?

To treat hyperkalemia effectively, you must understand why a patient gets hyperkalemic in the first place and how each treatment option works.