82 Hyperkalemia
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10. Labs: SMA 7&12, phosphate, Mg. 24h urine calcium, potassium, phosphate,
magnesium.
Hyperkalemia
1. Admit to:
2. Diagnosis: Hyperkalemia
3. Condition:
4. Vital signs: q4h. Call physician if QRS complex >0.14 sec or BP >160/90,
<90/60; P >120, <50; R>25, <10; T >38.5
C.
5. Activity: Bed rest; up in chair as tolerated.
6. Nursing: Inputs and outputs. Chart QRS complex width q1h.
7. Diet: Regular, no salt substitutes.
8. IV Fluids: D5NS at 125 cc/h
9. Special Medications:
-Consider discontinuing ACE inhibitors, angiotensin II receptor blockers,
beta-blockers, potassium sparing diuretics.
-Calcium gluconate (10% sln) 10-30 mL IV over 2-5 min; second dose may
be given in 5 min. Contraindicated if digoxin toxicity is suspected. Keep 10
mL vial of calcium gluconate at bedside for emergent use.
-Sodium bicarbonate 1 amp (50 mEq) IV over 5 min (give after calcium in
separate IV).
-Regular insulin 10 units IV push with 1 ampule of 50% glucose IV push.
-Kayexalate 30-45 gm premixed in sorbitol solution PO/NG/PR now and in q3-
4h prn, up to 5 times per day.
-Furosemide 40-80 mg IV, repeat prn.
-Consider emergent dialysis if cardiac complications or renal failure.
10. Extras: ECG.
11. Labs: CBC, platelets, SMA7, magnesium, calcium, SMA-12. UA, specific
gravity, Urine sodium, pH, 24h urine potassium, creatinine.
Hypokalemia
1. Admit to:
2. Diagnosis: Hypokalemia
3. Condition:
4. Vital signs: Vitals, urine output q4h. Call physician if BP >160/90, <90/60;
P>120, <50; R>25, <10; T >38.5
C.
5. Activity: Bed rest; up in chair as tolerated.
6. Nursing: Inputs and outputs
7. Diet: Regular
8. Special Medications:
Acute Therapy:
-KCL 20-40 mEq in 100 cc saline infused IVPB over 2 hours; or add 40-80
mEq to 1 liter of IV fluid and infuse over 4-8 hours.
