Potassium shifts and dialysis

From the "mistakes were made" file: Patient's AM potassium level came back extremely high. Albuterol and insulin were used to get the levels down in the short term (by shifting potassium into the cells). Dialysis was confirmed for that day. When the nephrologist came in, he pointed out that he was unable to dialyze out the potassium while it was stuck in the patient's cells. Ultimately, no harm done for a patient who lives at a high potassium level, but not optimal. Take-away lesson: if the patient is asymptomatic (bedside monitor necessary) and dialysis is immanent, better not to treat a high potassium level pharmacologically.

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