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:
The correct answer is A. Sodium polystyrene sulfonate 15 grams by mouth.
Explanation:
In the case of acute renal injury (AKI), the client has a significantly elevated potassium level of 6.7 mEq/L, which indicates hyperkalemia. This condition can lead to serious cardiac complications, such as arrhythmias, and must be addressed promptly.
Sodium polystyrene sulfonate (Kayexalate) is a medication specifically used to treat hyperkalemia. It works by exchanging sodium ions for potassium ions in the intestine, thereby promoting the excretion of potassium in the stool. Administering this medication will help reduce the client’s potassium levels effectively. Given the critical potassium level, this intervention should be prioritized.
Let’s briefly consider the other options:
- B. Sevelamer is primarily used to manage hyperphosphatemia in patients with chronic kidney disease (CKD) and is not indicated for hyperkalemia.
- C. Calcium acetate is a phosphate binder that helps manage hyperphosphatemia, not hyperkalemia, and while calcium can help stabilize the cardiac membrane in acute hyperkalemia situations, it does not lower potassium levels.
- D. Epoetin alfa is a medication used to stimulate red blood cell production in cases of anemia, particularly in chronic kidney disease. It does not address the hyperkalemia and is not an immediate priority.
- E. Calcium acetate (listed again, possibly a typographical error) serves the same purpose as noted previously.
Given the elevated potassium level, Sodium polystyrene sulfonate is the most appropriate and urgent medication to administer first to protect the patient from potential complications associated with hyperkalemia. The prompt treatment of high potassium levels is crucial in managing patients with AKI, emphasizing the importance of addressing hyperkalemia swiftly and effectively.