My nutrition support rotation has been much less busy than the others, mainly because we have very few new patients right now. There was a lot of excitement today, however, when we discovered that a patient (CF, lung transplant, d/c CVVHD) had a K level of 6.0 at 3 am and was receiving K in her TPN. A potassium level above 5.5 puts you a high risk of heart attack. We checked her afternoon labs and K was up to 6.6!
We paged the MD with an urgent request to discontinue the TPN, and then went up to the unit to check on the patient. Luckily the MD was already in the room next door and gave a verbal order for the nurse to d/c the TPN. The MDs had already asked for a Kayexalate enema and given insulin/D50 to bring down her K, and we ordered a bag of TPN without K for tomorrow. The insulin/D50 thing really confused me at first, but apparently administering them together basically induces refeeding syndrome that makes the K levels drop temporarily. (The biochemistry is explained here.)
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