A client with acute renal injury (AKI) weighs 110.3 pounds (50 kg) and has a potassium level of 6.7 mEq/L (6.7 mmol/L) is admitted to the hospital. Which prescribed medication should the nurse administer first?
Reference Range:
Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)]
A Sodium polystyrene sulfonate 15 grams by mouth.
B Sevelamer one tablet by mouth.
C Calcium acetate one tablet by mouth.
D Epoetin alfa, recombinant 2,500 units subcutaneously.
E Calcium acetate one tablet by mouth.
The Correct answer and Explanation is:
Given the scenario, the correct answer is:
A. Sodium polystyrene sulfonate 15 grams by mouth.
Explanation:
The client presents with acute renal injury (AKI) and a potassium level of 6.7 mEq/L, which is significantly elevated above the normal reference range of 3.5 to 5 mEq/L. This condition is known as hyperkalemia, a common and potentially life-threatening complication of AKI. Hyperkalemia can cause severe cardiac arrhythmias and requires prompt treatment to lower potassium levels.
Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestine. This process helps remove excess potassium from the body through fecal elimination. Given the patient’s critically high potassium level, administering sodium polystyrene sulfonate is a priority to help manage and reduce potassium levels.
Why Not the Other Options?
B. Sevelamer: This medication is used to manage hyperphosphatemia in patients with chronic kidney disease by binding phosphate in the gut, not by lowering potassium levels.
C. Calcium acetate: This is used to control hyperphosphatemia in patients with chronic kidney disease. While it helps control phosphate levels, it does not address high potassium levels.
D. Epoetin alfa: This medication is used to treat anemia by stimulating erythropoiesis but does not affect potassium levels.
E. Calcium acetate (repeated): As stated above, it is used for phosphate control, not potassium management.
Summary
The immediate priority in this case is to address the hyperkalemia, as it poses an urgent risk to the patient’s cardiac function. Sodium polystyrene sulfonate is specifically indicated for this condition and will help lower the elevated potassium levels. The other medications listed are important for managing other aspects of kidney disease but are not directly relevant to the acute management of hyperkalemia.