A patient in acute renal failure presents with a potassium level of 6.9 mg/dL.He has had no urine output in the past 4 hours despite urinary catheter insertion and Lasix 40 mg intravenous push.Vital signs are as follows: HR, 76 beats/min; respiratory rate, 18 breaths/min; and BP, 145/96 mm Hg.He is given 100 mL of 50% dextrose in water and 20 U of regular insulin intravenous push.A repeat potassium level 2 hours later shows a potassium level of 4.5 mg/dL.What order would now be expected?

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Quizplus · Accepted Answer

This patient appears to be in acute anuric renal failure.The potassium was not eliminated from the body; it was simply shifted intracellularly.Soon the potassium will return to the bloodstream, and the Kayexalate will help permanently remove it from the body.Lasix is not expected to work in the presence of anuria.The patient's vital signs do not support hypovolemia.In the presence of anuria, a large fluid infusion can precipitate congestive heart failure.

A Patient in Acute Renal Failure Presents with a Potassium