DISQUS

Richard V. Paul, M.D. · 3 years ago

I agree, and would also like to point out:
1) Kayexalate would never be approved today - the original description of its effects, leading to FDA approval and marketing, included less than 20 patients. It is ineffectual (Kapral et al, Journal of the American Society of Nephrology, Vol 9, 1924-1930, 1998), unpleasant,and in combination with sorbitol can produce colonic necrosis, as documented in a NEJM CPC a few years ago. I can't believe anyone would recommend it for potassiums of between 5 and 6 - in fact, the normal range in most labs is up to 5.3 or 5.5, and mild elevation above this level is nearly always inconsequential.

2) I have seen 2 cases of full thickness skin necrosis of the forearm - 1 leading to a lawsuit that was settled for a substantial sum - from calcium chloride pushed into a presumably infiltrated peripheral IV. Calcium chloride has a very low pH and is painful to receive rapidly in undiluted form in a peripheral vein under the best of circumstances. IMHO,calcium gluconate should be the preferred agent, unless reliable central venous access has been established or the patient is near cardiac standstill.

Tyson Lewis · 3 years ago

How does the Albuterol work in reversing hyperkalemia? I was taught to push Bicarb and Calcium if you've got significant EKG changes with alterations in mental status and/or cardiac arrest. And is it worthwhile to push the Lasix if the patient is in arrest?

To be honest, i definetly feel that metabolic imbalances is a weak point in my clinical knowledge. So one last question: I am a paramedic in New York city. If I have a patient with end stage liver failure in cardiac arrest that is unresponsive to standard therapies plus Bicarb administration, is it worthwhile to transport the patient still in arrest, or should we just pronounce?

Anonymous · 3 years ago

You mention the patient discomfort associated with Kayexalate (sodium polystyrene sulfonate). This is from the drug itself, or just the sorbitol base? Would another liquid base, such as water alone, be better?

KidneyNotes · 2 years ago

Answers to comments.

* Albuterol drives potassium into the cells.

* I don't think lasix is worthwhile if the person is in cardiac arrest.

* Re the person with liver failure: probably best to follow whatever the paramedic protocol is for pronouncements, but it sounds like they won't make it.

* Re Kayexalate: As an inpatient, kayexalate is usually mixed with sorbitol, which causes the discomfort. Kayexalate powder, which can be purchased as an outpatient, is mixed with water and actually is constipating.

Michael · 1 year ago

Well, my particular grievance is that almost no physicians, and certainly no nurses, know that Kayexalate is intended to produce the cationic exchange of sodium and potassium in the large intestine. If Kayexalate is mixed with a laxative, like sorbitol, patients may certainly develop diarrhea--and that is a good thing if you are trying to unload potassium. But we do not give Kayexalate to produce diarrhea--in fact, Kayexalate is constipating, if anyhing. Still, it not rare to receive a call from a worried nurse who reports that a pt has received 30g of Kayexalate but has still failed to fill his sheets with diarrheal stool as intended.