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?

[u/Little_Blackberry588]

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?

[u/biobag201]

Thank you! I had this conversation with an icu doc after he criticized me intubating a dka and hhs (bsg was 1000) with a ph of 7.16 and a rr of a peaceful 8. I literally said “dude this guy is pre arrest, his rr rate should be in the 20’s minimum”

[u/dMwChaos → u/biobag201]

Damned if you do, damned if you don't.

Sometimes we just have to make difficult decisions.

[u/Eh_for_Effort → u/dMwChaos]

Some specialities aren’t comfortable rolling the dice when you have to

[u/[deleted] → u/Eh_for_Effort]

I don't even see that as rolling the dice. How much minute ventilation are you actually losing for the tube with a resp rate of 8?

Now tubing the patient breathing at 30 because "they're going to tire out..." Uncool.