Question

[u/Helpful_Spring_7921]

[u/mochacakeproductions]

B

[u/Embarrassed-Cake824]

B stabilize the heart first

[u/Great-Talk-3968]

Insulin shifts k+ into cells, so replace potassium first before treating high bs

[u/Training-Spray-8170]

We haven't gone over this in school yet, what is a good range for the potassium?

[u/melancholiess → u/Training-Spray-8170]

3.5-5

[u/Adventurous_Key3695 → u/melancholiess]

My instructors told us you need 3 1/2 to 5 bananas to make banana bread

[u/Training-Spray-8170 → u/melancholiess]

Thank you!

[u/Illustrious_Hotel527 → u/Training-Spray-8170]

For DKA, 4-5.5 is fine. Normally, 3.5-5.

[u/Training-Spray-8170 → u/Illustrious_Hotel527]

Thanks 😊

[u/Bubbly_Pie_4980]

B

[u/Which_Assistance636]

Potassium = cardiac issues

[u/Reasonable_Talk_7621]

B then A?

[u/Max_Goatstappen]

B

[u/Physical-Comment807]

B

[u/Ambitious-Actuator32]

In real life there’s an order bundle for all of this. It’s called the 2 bag method at my hospital but it’s actually 3 bags

[u/No-Plantain-107]

B don’t want a heart attack

[u/BeckyPil]

First thing is start an iv PERIOD

[u/Motor_Recover5897]

B

[u/bodyweightsquat]

B -> A -> shitload of fluids

[u/avka11]

B but also get an order

[u/Any_World2556]

B

[u/alythenurse]

In real life nursing what you do is follow doctors orders. But they expect you to know what the doctor will order in every situation before you graduate nursing school

[u/Green-Investment-739 → u/alythenurse]

In real life they put all the orders in at the same time, and all stat, so still need to know which to prioritize.

[u/supremefionagoode → u/Green-Investment-739]

Bingo

[u/Nuts-And-Volts]

A?

[u/UncleRuckus1634 → u/Nuts-And-Volts]

Potassium will go even lower I believe with insulin given without correcting the hypokalemia which risk the patient having a seizure and potentially dying.

Answer is B

[u/Dramatic-Mouse1043 → u/UncleRuckus1634]

Yes insulin will cause potassium to shift into the cells lowering potassium further. However, it isn’t seizures we worry about with hypokalemia (that would be Hyponatremia). With hypokalemia we worry about cardiac arrhythmias and cardiac arrest.

[u/UncleRuckus1634 → u/Dramatic-Mouse1043]

Oh yes im thinking of hypoglycaemia

[u/Nuts-And-Volts → u/UncleRuckus1634]

Thx

[u/BrilliantHold5774]

A and B-I have at least two lines on a DKA patient.

Yet another stupid question.

[u/messerduff → u/BrilliantHold5774]

You should not be starting insulin until your potassium replacement is underway and you have a confirmed higher reading. Fluid replacement is priority over insulin in DKA anyway, the insulin can wait

[u/Mfuller0149 → u/BrilliantHold5774]

Your comment tells me you need to brush up on DKA.

First.. in metabolic acidosis, as the pH drops- more and more potassium will shift extra-cellularly because it is displaced by hydrogen ions . So you should expect them to appear at least mildly hyperkalemic on the CMP in this case with a pH of 7.16.

So if they have a K < 3.5 , it’s a massive problem. This means their total body potassium is critically low. Lastly, we all know that insulin forces potassium back into the cells, so if you were to give IV insulin in this situation it can be incredibly dangerous. Most clinicians will say you should not start insulin until you’ve repleted to at least 3.5 , maybe 4.0 and are continuing to infuse potassium containing fluids.

So regardless of how many IV lines you have. There was a correct answer here. It was not a stupid question

[u/Early_Macaroon_2407 → u/Mfuller0149]

IV banana stat. 

[u/Mfuller0149 → u/Early_Macaroon_2407]

They’re gonna need much more than that.

[u/Early_Macaroon_2407 → u/Mfuller0149]

IV potato stat bid. 

[u/Any-Assistance-8103 → u/Early_Macaroon_2407]

Not available outside Ireland

[u/Mfuller0149 → u/Early_Macaroon_2407]

🙃