Wednesday January 31, 2007
Q; Nurse call you with K+ level of 7.8 (lab confirmed - no hemolysis). You ordered 10 units of IV insulin with 2 ampules of D-50, 1 ampule of calcium gluconate and 2 ampules of sodium bicarbonate in series. RT was requested to give 2 nebulizer treatments of albuterol. The final order set is followed ultimately by PO Kayexalate/sorbitol.What is wrong in above orders for the management of hyperkalemia?
A; In the management of hyperkalemia, sodium bicarbonate should be given before calcium. Administrating bicarbonate after calcium will bind calcium and will render it ineffective. This is another reason, we don't prepare "bicarb drip" in LR (Lactated Ringer’s) as it contains calcium which will bind bicarbonate and will make the whole management ineffective.
posted by icupearls.org archive @ 4:05 AM
18 comments
18 Comments:
Why would you not give the calcium first for cardiac protection?
I agree, preferred first drug use is Calcium Chloride and not gluconate. After flushing with saline 10 ml, Bicarb is advised to be infused.
G. Dwivedi, MD.
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