Urgent High Potassium for my mom 6.6. Taking her to ER. What could be the cause?

[jo]

Here is the situation. By the end of last week, it was found out that my mom had some narrowing in the fistula and they did a fistulogram/angioplasty where they did the balloon technique to fix and expand her narrowed vein. Starting from the next day after the procedure, she was dialyzed thrice this week from Monday thru Thursday. Even after 3 session of dialysis, the lab found out that the potassium levels didn't drop and is staying the same (today's results shows 6.6). What could be the reason behind this? We are taking my mom to the ER as suggested by the dialysis charge nurse. I think she ate tomatoes more than usual, but I was concerned about the potassium levels not going down even after 3 dialysis sessions. Could this be a problem with the angioplasty that was done and was not very effective? Also, she is on warfarin right now due to a blood clot found in her heart. Any suggestions will be greatly helpful. Thanks.

[obsidianom]

Here is the situation. By the end of last week, it was found out that my mom had some narrowing in the fistula and they did a fistulogram/angioplasty where they did the balloon technique to fix and expand her narrowed vein. Starting from the next day after the procedure, she was dialyzed thrice this week from Monday thru Thursday. Even after 3 session of dialysis, the lab found out that the potassium levels didn't drop and is staying the same (today's results shows 6.6). What could be the reason behind this? We are taking my mom to the ER as suggested by the dialysis charge nurse. I think she ate tomatoes more than usual, but I was concerned about the potassium levels not going down even after 3 dialysis sessions. Could this be a problem with the angioplasty that was done and was not very effective? Also, she is on warfarin right now due to a blood clot found in her heart. Any suggestions will be greatly helpful. Thanks.

What were her other labs? Were the other labs such as phosphorus, and calcium and sodium etc ok? In other words was the potasium as isolated bad lab or were all the numbers off? If all the labs were off, then I would be concerned with poor dialysis from the fistula not working well. If its just the potassium it could be what she ate and possibly meds she is on such as some blood pressure meds.

[jo]

Here is the situation. By the end of last week, it was found out that my mom had some narrowing in the fistula and they did a fistulogram/angioplasty where they did the balloon technique to fix and expand her narrowed vein. Starting from the next day after the procedure, she was dialyzed thrice this week from Monday thru Thursday. Even after 3 session of dialysis, the lab found out that the potassium levels didn't drop and is staying the same (today's results shows 6.6). What could be the reason behind this? We are taking my mom to the ER as suggested by the dialysis charge nurse. I think she ate tomatoes more than usual, but I was concerned about the potassium levels not going down even after 3 dialysis sessions. Could this be a problem with the angioplasty that was done and was not very effective? Also, she is on warfarin right now due to a blood clot found in her heart. Any suggestions will be greatly helpful. Thanks.

What were her other labs? Were the other labs such as phosphorus, and calcium and sodium etc ok? In other words was the potasium as isolated bad lab or were all the numbers off? If all the labs were off, then I would be concerned with poor dialysis from the fistula not working well. If its just the potassium it could be what she ate and possibly meds she is on such as some blood pressure meds.

Thanks Doctor. The other lab results were not out yet. At the dialysis clinic, they said that they will be out tomorrow. Since the lab found high potassium levels, they informed the clinic right away.

[jeannea]

I don't know why her potassium is too high. You're doing the right thing by going to the ER. She needs to be where they can take care of her and watch for problems. I suspect she'll be admitted. They can schedule dialysis and treatment for her fistula if necessary. I hope things get better soon.

[Jean]

Me too, dealing with things, especially high potassium, can be very nerve wracking. Best of luck to you.

[del]

It could be from poor dialysis or from something she has been eating.  Check the list of high potassium foods that she may have been eating.  Some examples are bananas, oranges, orange juice.  Google high potassium foods and you will get a list.

[dialysisuser82]

Does she eat a lot of bread? 

I had an incident where I ate a whole loaf of Italian bread and the Potassium shot up!  I could feel it because my breath was like uremia, my leg muscles got really weak.  On the next dialysis they did

a K-Stat and surely my Potassium was 7.2.

Another thing could be if the CO2 is low, meaning did she eat food that are acidic, e.g. pickles, lime etc...?

Recently my Potassium was 6.9 and the neph. said it was because my CO2 was low, at 16 which would cause an increase in the Potassium. If that is the case then the Sodium Bicarb needs to be adjusted.

hope this help,

[jo]

Thanks everybody for your responses. We went to the ER that day and they did a blood exam for potassium and found out the result to be normal which was 5.5. We are still confused with how the number dropped all the way to 5.5. We were told it was 6.8 based on that month's lab results and that's when we were asked to go to the ER. We were happy to find out it was 5.5, but I am still wondering how this happened. Any ideas?

[jo]

Does she eat a lot of bread? 

I had an incident where I ate a whole loaf of Italian bread and the Potassium shot up!  I could feel it because my breath was like uremia, my leg muscles got really weak.  On the next dialysis they did

a K-Stat and surely my Potassium was 7.2.

Another thing could be if the CO2 is low, meaning did she eat food that are acidic, e.g. pickles, lime etc...?

Recently my Potassium was 6.9 and the neph. said it was because my CO2 was low, at 16 which would cause an increase in the Potassium. If that is the case then the Sodium Bicarb needs to be adjusted.

hope this help,

No, she doesn't eat bread. But I think she ate more tomatoes that week than usual. That's it. Thanks for letting me know about the low CO2 issue.

[jo]

Ok there is one more thing that I needed to check with you guys. The doctor has a note for my mom saying that her dry weight should be 55 kg. She has never achieved that target so far. She does dialysis 3 times a week. Before every session, she weighs around 60 kg even after sticking with the renal diet and fluid restrictions. She gains 3 kg between treatments. At the dialysis center, they try to take 4L off of her in 3.5-4 hours in every session to achieve the target weight of 55 kg. This would cause cramping and they finally end up taking about 3L which leaves her at about 57 kg at the end of dialysis. To get her close to her dry weight, they asked her to come for additional treatment this week. She went yesterday and she was at 57 kg at the end of dialysis as usual. When she went for dialysis today, they were not able to pull fluids off of her as her blood pressure kept dropping constantly and they ended up pulling 1L at the end. Could this constant drop in blood pressure due to less or no more fluid in her body? Does this mean that her dry weight be set to 57 instead of 55? Let me know if anyone has ideas.

[obsidianom]

Ok there is one more thing that I needed to check with you guys. The doctor has a note for my mom saying that her dry weight should be 55 kg. She has never achieved that target so far. She does dialysis 3 times a week. Before every session, she weighs around 60 kg even after sticking with the renal diet and fluid restrictions. She gains 3 kg between treatments. At the dialysis center, they try to take 4L off of her in 3.5-4 hours in every session to achieve the target weight of 55 kg. This would cause cramping and they finally end up taking about 3L which leaves her at about 57 kg at the end of dialysis. To get her close to her dry weight, they asked her to come for additional treatment this week. She went yesterday and she was at 57 kg at the end of dialysis as usual. When she went for dialysis today, they were not able to pull fluids off of her as her blood pressure kept dropping constantly and they ended up pulling 1L at the end. Could this constant drop in blood pressure due to less or no more fluid in her body? Does this mean that her dry weight be set to 57 instead of 55? Let me know if anyone has ideas.

I cant give direct advice but I do beleive in general in the US we try to take off too much fluid on patients. I really beleive less is better. Her dry weight is a hard thing to get exact anyway as it is always a guess. My own perspective is the higher number of 57 sounds more reasonable. If they tried leaving it there they could see if she had breathing trouble or swelling. If she didnt have problems at 57 then they should use that number. I would argue wth them to try it for awhile and see.

[Hazmat35]

I recently had a discussion w/ my Facility Administrator and Doctor the other day; and they suggested, that maybe I was getting dehydrated in between treatments...trying to keep the fluids down; I'm not drinking enough!!!!!!  When they go to pull fluids, nothing to come off; my BP starts dropping and they have to add Saline...!  Don't know if that will help with anything....

[cattlekid]

My other question on dry weight is has your mom been constipated lately?  If you have trouble moving your bowels, your pre-dialysis weight may be up but it may not be due to fluid.

Remember, dry weight is an art, not hard science.  I always felt better with a half kilo more than my "dry weight" when I was in center.  So one day I asked my doctor if my dry weight could be changed.  He asked what I wanted it to be changed to.  When I told him I wanted it to be increased a half-kilo, he kind of rolled his eyes, asked why I would be so hesitant to make such a request and made the change in the computer right away.

[cdwbrooklyn]

Please be very careful when it comes to dry weight because no one dry weight stays the came forever.  Your mom may have gained body weight not fluid.   The techs and doctors false to realize that dry weight changes as your appetite increases.  If a person blood pressure drops, it is an indication that that person is taking off too much water weight.   Your body speaks to you so listen to what it’s saying.  Tell the techs to take off enough water so your mom will not overload with water.  It’s okay to leave on a little bit of water because your body needs water.   

My appetite constantly changes and I am gaining and losing weight every month so my dry weight changes every month.   

Hope this helps. 

[Michael Murphy]

When I started dialysis I weighed 150 kilos and since I was fat every one concluded I was retaining fluid so the doctor picked a aggressive dry weight and put me on a 40 oz fluid limit.  So every session it was 4 or 5 kilos off and I felt like hell.  This continued for several months until one day I went to see the nephrologist and my blood pressure was 75 over 45.  My dry weight was adjusted up that day and the fluid restriction was lifted.  What I drink I put out I know that this won't last but as long as it does I will enjoy my water.  However I have learned that if I have not drank enough and I get a tech that thinks they need to challenge my dry weight I am going to get constipated, bricked up.  So the next session it will appear that I am several kilos over my dry weight.  Thats when I put my foot down and tell the techs what they can remove.  I monitor my fluid retention with my wedding ring,  if it comes off easy no fluid. tight fluid.  I also once a month measure what I drink and what I pass if the numbers are close I fine for another month.

[jo]

Thanks everyone. We really don't know how to deal with this and our family is really suffering seeing my mom's condition. She is at the center right now. When she went in, she weighed 59.1 kgs and they are trying to pull off 3.6L. Her blood pressure is constantly dropping and raising and is not letting her dialyze. I think we really need to talk to the nephrologist to fix this problem. Also, she takes a blood pressure medication carvedilol every morning even during dialysis days. Does anyone think this would affect the blood pressure during dialysis?