1. Admit to: [ ] Medical floor [ ] Telemetry [ ] ICU |
2. Attending Dr: _________________ phone: ______-________. Attending (PC): _________________ |
3. Admitting Dx: Hyperkalemia |
4. Contributing Dx: |
5. Condition: |
[ ] Stable [ ] Fair [ ] Serious [ ] Critical |
6. VS: |
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Vitals, neurochecks (weakness, arreflex, parethesias, paralysis), postural BP, urine output Q 4 hr;
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call MD if: P < 50 or > 120, BP < 90/50 or > 160/90, R > 25 or < 10; T > 101.5°F; neuro changes. |
7. Activity: |
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8. Nursing: |
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I/O Q shift.
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Weight now and daily.
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ECG (look for tall T wave, prolonged PR, ST depression, depress or absent P, wide QRS); cardiac monitoring (bradycardia, VF, asystole); arrhythmia protocol. |
9. Diet: |
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10. IV: |
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11. Meds: |
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Calcium gluconate: 10% 5-10 cc IV over 2-5 min; second dose may be given in 5 min; may repeat Q 1 hr prn Sx. If dig toxicity suspected, give over 30 min or omit.
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NaHCO3 (Sodium bicarbonate): one amp of 7.5% IV over 5 min (give after calcium in separate IV), repeat in 10-15 min followed by 1-2 amps added to D5W titrated over 2-4 hr.
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Insulin: 10 U regular in 500 cc of D10W IV over 1 hr or 10 U IV push with 1 amp 50% glucose (25 gm) over 5 min, repeat as needed Q 3 hr.
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Kayexalate: 15-50 gm in 100 cc of 20% sorbitol solution PO now and 3-4 hr, up to 4-5 doses/day or Kayexalate retention enema 25-50 gm in 200 cc of 20% sorbitol; retain for 30-60 min (may use cleansing enema before).
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Furosemide: 40-80 mg IV Q day; consider discontinuing NSAIDs, ACEI, beta-blockers, K-sparing diuretics. |
12. Other Meds: |
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Tylenol 500 mg 1 or 2 PO Q 4 hr prn pain,/temp > 101°F;
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Maalox 30 cc PO Q 4 hr prn indigestion;
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MOM 30 cc PO Q 12 hr prn constipation;
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Benadryl 50mg PO Q hs prn insomnia. |
13. Labs: |
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CBC, SMA 7/SMA 12, Mg, Ca, AGG; K Q 4-6 hr.
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Urinalysis with micro, osm, Na, K, bicarb, Cl.
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Consider serum lactate, sickle prep, retic, cortisol, renin, aldosterone, urine myoglobin and 25 hr urine K, Na, Cr, prot, cortisol. |
14. Other: |
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