Nephrology Question 17 Instructor

You are called to assess a 45 year old male with diabetes and chronic kidney disease from diabetic nephropathy. He has been admitted to the hospital with a diagnosis of pneumonia. You are told he has:

Serum K = 6.9 mmol/L
HCO3 = 24
Cr = 180 micromol/L

Write your orders for the initial management of this patient’s hyperkalemia. Include doses where indicated.

Typical orders would include:

  • Establish IV access.
  • Stat ECG
  • IV calcium gluconate (if not taking digoxin)
  • IV Humulin R 10-20 units X 1 dose
  • IV D50W 1 AMP X 1 dose
  • Blood sugar with bedside glucometer hourly
  • Calcium resonium 30 gram in 50 cc of 70% sorbitol (if nocontraindication)

For a more detailed review on hyperkalemia, try the following links:

Palmer, Biff F. Managing Hyperkalemia Caused by Inhibitors of the Renin-Angiotensin-Aldosterone System. N Engl J Med 2004 351: 585-592 (PubMed)

Disorders of Potassium and Acid-Base Balance. American Journal of Kidney Diseases. May 2005 (Vol. 45, Issue 5, Pages 941-949) (PubMed)

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