r/emergencymedicine • u/Little_Blackberry588 • Sep 09 '24

Advice Rapid potassium repletion in a pericoding patient with severely low K of 1.5 due to mismanaged DKA at outside hospital. How fast would you replete it? What is the fastest you have ever repleted K?

I repleted 40 meq via central line in less than an hour, bringing it up to 1.9. The pharmacist is reporting me for dangerously fast repletion. What I can tell you is the patient was able to breath much better shortly after the potassium was given. Pretty sure the potassium was so low he was losing function of his diaphragm. Any thoughts from docs or crit care who have experience with a similar case?

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u/tcc1 Sep 09 '24

i didnt say i know everything, but i know how to manage my critical care patients in the ER setting. that is quite fucking literally my job. its not to consult someone else to do it. this isn't an esoteric scenario that may never happen. it's like going to the ER and consulting CC for anaphylaxis. waiting to ask someone else how to do your job is not what you should be doing so yeah, there is a downside

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u/fencermedstudent Sep 09 '24

Do you only call consults when you have zero clue what to do? I don’t think I’ve ever gotten on the phone w someone without a game plan.

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u/tcc1 Sep 09 '24

.. says the guy who is calling ICU to make sure their game plan of REPLETING THE FUCKING LIFE THREATENING K IS OKAY? are you even board certified bro. that's med student level of not suredness

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u/Eh_for_Effort Sep 09 '24

This patients disposition is ICU. Early ICU involvement while getting a central line in and smashing them with potassium is a good idea, if nothing else but to get another knowledgeable set of hands in case it all goes to shit

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u/tcc1 Sep 10 '24

yeah dispo is definitely ICU. but stabilize the patient. this is in the realm of the emergency physician.

you're not calling the ICU when the patient needs an airway. you shouldnt be calling wasting time calling them when they need IV K (and probably mag) started. At my place you get an NP at night so good luck with that.

I'm all for more hands on deck if you think tehre's a net gain but I don't think so here