Potassium of 7.5 Doc... in a very haemolysed sample.... but with urea of 68 and creatinine of 450.... what do u wanna do doc.... Previously all normal blood.... (EXTREMELY DIFFICULT TO BLEED.... SEVERE DEHYDRATED)
(For those non medic out there... high potassium meaning bad... dammm bad.... can die one ... well... and this post might be extremely boring for you... can stop reading now.... )
-_-'''
That's exactly my expression when i received that call from the ward....
What would you do?
(A) Call For Help
(B) Ignore it
(C) Go and see the patient while ask for an ECG
(D) Continue flirting with A&E Nurse
For those who knows me well... my answer obviously is (D).... :-þ
No... i did not.... (C) was what i did.... that's what we all do anyway.... get a ECG and normally it's normal so just ignore it then repeat another sample... and pray hard it's just because of the haemolysed sample...
BUT... this time round.... ECG showed stonking Tall tented T wave V2-V3... Flatenned P Wave... just the type of ECG u will see when u flip open the ALS book... So the next question is... to TREAT or not ??
(A) Give Calcium Gluconate and rpt sample
(B) Give Insulin+Dex and Salbutamol Nebs
(C) Ignore it
(A) that what i did... it did not get better.... K+ came back 8.9 -_-'''''''''' Steady and calm... gave (B) now.... done Blood Gas.... pH 7.25, PCO2 3.8, PaO2 13.8, HCO3 17, BE -9.5... what else can i do now??? Having just done ALS... Sodium Bicarb the next step??? if not she will just get Cardiac arrest because i did not manage to reverse the reversible cause... Ppl... what would u do?? let me know....
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2 comments:
add calcium resonium? i dont know whether you can repeat calcium gluconate, insulin or salb nebs... but if the K+ is persistently high more than 8.0, wont you do a dialysis?
with a cr of 450 its unlikely that the raised K is due solely to haemolysis. There is def a large degree of renal failure. After the ECG go for insulin-dex, gluconate AND resonium, and start liaising with ICU for RRT?
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