A nurse inadvertently infuses an IV solution containing potassium chloride too rapidly. Which of the following is an appropriate intervention advised by the physician?

1. A

   Rapid infusion of IV Ringer's solution

2. B

   Rapid infusion of IV NS 0.9%

3. C

   Insulin added to 10% dextrose in water solution

4. D

   Administration of albumin

Appeared in: SCTIMST Staff Nurse - 2016

Explanation

• The primary emergency treatment for acute hyperkalemia is to shift potassium from the bloodstream into the cells.
• Intravenous regular insulin activates the Na+/K+-ATPase pump, which effectively moves potassium into the cells.
• Dextrose (e.g., 10% or 50%) is administered simultaneously to prevent the patient from becoming hypoglycemic as a side effect of the insulin.
• This combination begins to lower serum potassium within 10-20 minutes, making it a rapid and life-saving intervention.

Why Other Options Were Wrong

• Option A: Ringer's solution contains potassium (around 4 mEq/L). Administering it would add more potassium to the bloodstream, worsening the hyperkalemia.
• Option B: While 0.9% Normal Saline can help increase urinary excretion of potassium, it is not the most rapid method for lowering serum levels in an emergency. It does not cause an intracellular shift of potassium.
• Option D: Albumin is a plasma volume expander used to treat conditions like shock, burns, or hypoalbuminemia. It has no effect on serum potassium levels.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Management of Acute Iatrogenic Hyperkalemia helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses must always use an infusion pump for IV potassium and adhere to maximum infusion rates to prevent iatrogenic hyperkalemia, a potentially fatal error.
• Recognizing ECG changes associated with hyperkalemia (peaked T waves, wide QRS) is a critical nursing assessment skill. Immediate reporting can save a patient's life.
• What if the patient with hyperkalemia also shows significant ECG changes like a very wide QRS complex? The priority intervention, even before insulin/dextrose, would be administering IV calcium gluconate to stabilize the cardiac membrane and prevent imminent arrhythmia.

How to Approach the Question

• First, identify the core problem in the scenario: a rapid infusion of potassium chloride directly causes acute, severe hyperkalemia.
• Next, understand the immediate threat: hyperkalemia poses a life-threatening risk of cardiac arrhythmias and cardiac arrest.
• Evaluate each option based on its mechanism and speed of action in treating hyperkalemia.
• Option A (Ringer's) adds potassium, making it harmful. Option D (Albumin) is irrelevant.
• Compare Option B (NS) and Option C (Insulin/Dextrose). NS promotes slower renal excretion, while Insulin/Dextrose causes a rapid shift of potassium into cells.
• Conclude that the most appropriate and rapid emergency intervention is the one that shifts potassium intracellularly, which is insulin and dextrose.

Concept Tested & Keywords

• Concept Tested: Management of Acute Iatrogenic Hyperkalemia
• Stem keywords: inadvertently infuses, IV solution, potassium chloride, too rapidly
• Lead-in keywords: appropriate intervention
• Clinical cues: Rapid infusion of potassium chloride is a critical event that directly causes acute hyperkalemia.

Question ID

QzZU8QWiICc72Xhux_F_Gi

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 1 p. 402-404

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 543-545

E6 Medicine Davidson Principles Practice 24e p. 383-385