My K became too elevated for the first time since I've been on dialysis. Nothing was said to me about it. I kept inquiring about it as my K results did not come back on my labs. They said it was spun wrong. I finally got the results and learned that they had switched me to a 1k bath (was on a 2). Shouldn't my staff have told me my results as soon as they knew so I would know to check whatever I was doing wrong? I had added 2 cups a day of watermelon to my diet, the dietitian having told me it was safe to do. At what point can high K kill you? Mine went up to 6.3.

Also, the conductivity of my machine had been running at 14.1-14.2. Since they've put me on a 1K bath, my conductivity now runs 13.8-13.9. I now feel achey/crampy the last hour and the next day I am still sore.
Does a lowered bath affect the conductivity rate? When my conductivity was higher I had all good txs..not anymore.

A lower potassium chloride, while all other constituents (like sodium, calcium, and magnesium chlorides) remain the same, will result in a lower conductivity.

However, the reason you feel aches and cramps at the end and after treatment would more likely be due to a low potassium. Ask to have a potassium level drawn at the end of treatment using the same technique used to draw a post BUN.

Thank you. My nurse told me that K comes down fairly quickly. She said something about the regular weekly test for K not being really accurate. I didn't get what she meant. I'll request the post Bun method and hopefully get back to a 2K asap.

An important question is, what else besides lowered K can produce the same last hour symptoms of tightness in legs, pressure on heart, diminishment of mental capacity? These symptoms (very scarey I might say..have to clutch my heart) are totally absent as long as I dialyze on this same machine which has a conductivity of 14.2, and higher, when its using a 2k bath. But when I have been on a machine with a lower conductivity of 13.9, or less, and a 2K bath, I have gotten the identical symptoms?

At this last tx, there was 30 min. left to go when I discussed the symptoms with the nurse. She said she could put me back on a 2K for the remainder of the tx. We didn't end up doing it as I couldn't make a decision that fast without info. and she decided we'd get the weekly lab results by the next tx. Would it have been safe to change the K back to a 2 the last 30 min.? What options can be taken when a patient is in distress like this? It can't be good to just ride it out. I had the tech give me 50 ccs of saline twice. Another thing I've noticed, is that since I've been on the 1K bath (3 txs now), my final weight has come out .1 below my target goal. I normally come out at my goal or .1 higher on this machine.

Dialysis works by the difference of concentrations in the blood and dialysate. There is no urea in fresh dialysate and therefore, urea dialyzes at the fastest rate possible for any given dialyzer and combination of blood and dialysate flows. The potassium in the dialysate slows the rate that potassium dialyzes - a higher dialysate potassium results in slower removal of potassium, and therefore, less total potassium removed during a given treatment.

I have known physicians to order changing the potassium level during the treatment in order to remove the most potassium possible while still avoiding adverse effects. Using a low K+ for the first part of the treatment, then changing back to a normal potassium for the final portion is an acceptable means to treat a high pre-dialysis serum potassium. However, the best solution would be to eliminate the cause of the high potassium (and it isn't 4 cups of watermelon

There are several things that could cause the symptoms you are describing. What is your bp toward the end of the treatment? It could be something as simple as running you on a sodium variation to keep the conductivity higher and maintain your bp.
Has your dry weight been reevaluated? Perhaps you need to have it adjusted. Does your facility offer UF profiling (this allows additional fluid to be removed at times when a person can tolerate it best)?
How long have you been dialyzing? I do not recommend you "just ride it out" the technology available allows for a great deal of customization for treatments. What we have to do is get your specifics and fine tune the treatment which will serve you best.

Your nephrologist needs to be involved if you haven't already done so. Your involvement in your care does not extend to directing clinical staff when to give you saline or when to change dialysate composition during your treatment. A little knowledge in the wrong hands can be dangerous. The liability for these decisions still remains with the licensed professionals, not the patient.

quote:

Originally posted by Patient:
Thank you. My nurse told me that K comes down fairly quickly. She said something about the regular weekly test for K not being really accurate. I didn't get what she meant. I'll request the post Bun method and hopefully get back to a 2K asap.

An important question is, what else besides lowered K can produce the same last hour symptoms of tightness in legs, pressure on heart, diminishment of mental capacity? These symptoms (very scarey I might say..have to clutch my heart) are totally absent as long as I dialyze on this same machine which has a conductivity of 14.2, and higher, when its using a 2k bath. But when I have been on a machine with a lower conductivity of 13.9, or less, and a 2K bath, I have gotten the identical symptoms?

At this last tx, there was 30 min. left to go when I discussed the symptoms with the nurse. She said she could put me back on a 2K for the remainder of the tx. We didn't end up doing it as I couldn't make a decision that fast without info. and she decided we'd get the weekly lab results by the next tx. Would it have been safe to change the K back to a 2 the last 30 min.? What options can be taken when a patient is in distress like this? It can't be good to just ride it out. I had the tech give me 50 ccs of saline twice. Another thing I've noticed, is that since I've been on the 1K bath (3 txs now), my final weight has come out .1 below my target goal. I normally come out at my goal or .1 higher on this machine.

Thanks again for the support. I have been on dialysis for several years with good labs. Never touched a bite of watermelon until recently. It is supposed to be a moderate K as compared to the other melons. Ate 2 cups a day for a week and went from 5.8-6.3. So no more.

I have always been on a straight 140 sodium. I have found that as long as I'm on a machine calibrated for a higher conductivity of 14.2, and above, with my usual K2 bath, I have good txs. Machines calibrated for lower conductivity cause the last hour symptoms. I rarely gain or lose weight, but if I see my bps dropping I adjust my dw. I never exceed my fluid limit.

I have always wanted to fine tune the tx even more with sodium modeling and UF profiling, but have not proceeded because my staff is not educated in the technical aspects of the tx. I have been trying to find a way to get training in these techniques so that I can run my own tx, as I can't depend on my staff to get the training and support me. I understand basically how they work, but need more insight on what to do if I select a program and need to go up or down.

For my next tx, I will talk to my doctor about switching to the 2K bath at the end of the tx if I have the last hour symptoms.

I agree with "what?" and do not feel you should have to tell the staff what they can do to make your treatments more effective and less symptomatic. The staff should not be allowed to "not be educated" on the equipment they are using to treat patients. That is an unacceptable attitude!
What type of equipment are you dialyzing on? Please post that so we can discuss what options are available on that type of equipment. I would also make a point to discuss this with doc, director of nursing, charge nurse, administrator, whatever type of technical/biomed staff are at the unit. Also you may ask if you can have an operator's manual for the equipment at the facility. Usually the manufacturer provides one with each piece of equipment, so there should be extras floating around. The staff at this facility need to address your concerns and not give answers like "we don't know how", if you don't know how then you learn how, this is a service industry as well as healthcare and to not utilize all possible options to give the best treatments is not acceptable.

Quite right ! You can't afford to accept mediocrity from your caregivers. One day it will compromise your health. Good luck !

quote:

Originally posted by some more
thoughts:
I agree with "what?" and do not feel you should have to tell the staff what they can do to make your treatments more effective and less symptomatic. The staff should not be allowed to "not be educated" on the equipment they are using to treat patients. That is an unacceptable attitude!
What type of equipment are you dialyzing on? Please post that so we can discuss what options are available on that type of equipment. I would also make a point to discuss this with doc, director of nursing, charge nurse, administrator, whatever type of technical/biomed staff are at the unit. Also you may ask if you can have an operator's manual for the equipment at the facility. Usually the manufacturer provides one with each piece of equipment, so there should be extras floating around. The staff at this facility need to address your concerns and not give answers like "we don't know how", if you don't know how then you learn how, this is a service industry as well as healthcare and to not utilize all possible options to give the best treatments is not acceptable.

Returning to the discussion of what I hope will soon be a tx problem solved. The machine I dialyze on is a FR 2008H. I'm a patient who believes in being part of my tx team. It would be nice if I could just sit back, let the staff run the tx, and take a nap. But I have never shut my eyes in dialysis, because I've never had a staff that was technically well trained. I did dialyze once in a hospital acute unit where I encountered a higher degree of knowledgeable staff. I could ask questions there and get accurate answers. I have found that it is to my advantage, anyway, to have to know how to run my tx. Its better to be alert and a part of the decision making for my care. I don't just have a little knowledge. I have a considerable amount of growing knowledge after studying dialysis everyday for 3 years.

At the point we're at now, I saw the doctor and told him that checking my K each tx with a local lab is the advice other medical people have given me. He disagrees and says that the once a week testing which is sent to a lab across the country is sufficicient. Otherwise, he says, I'll become anemic. But he said if I insist on going to a local lab independently he will refer me. Only thing is, I can't have my blood drawn at my unit through my access.. I'd have to have it drawn through my other arm which is a risk to a future access. He says we have no one from the unit to take it to a local lab???

So, I'm in a holding pattern until I get furthur advice. From everyone I've consulted with, the K should be checked with each tx in a case like this. I've had 5 txs thus far on a 1K, and the last across the country lab of 2 txs ago said my K had dropped only 1 point to 6.2. The 1K bath seems to have the effect of intensifying the fluid removal. It brings me a little too close to my dry weight, taking me to the point of .1 below my target goal. So, I have taken off .2 less and that has helped relieve my symptoms somewhat the last two txs. My doctor says the 1K bath should have no effect on me. But I have experienced it definitely does change the dynamics of the tx producing uncomfortable symptoms. I actually have a very nice staff that I like very much, but it doesn't change the fact that they need more training. Can I make them get training? I wish I could. Are you guys biotechs or pcts? I appreciate any techinical instruction very much.

Patient,

Reducing the K in your dialysate from 2.0 down to 1.0 will have little if any effect on the conductivity (in theory it will reduce by 1 mS) so it will not affect your weight loss or any other "symptoms" you are experiencing. Your symptoms are more consistant with fluctuations in dry weight.

A K of 6.2 is slightly elevated but is far from being life threatening for a dialysis patient whos level has gradually increased as opposed to a sudden increase due to medication. A K of this level does not warrant checking it every treatment and in my opinion, weekly is also over-kill.

I have seen in posts that you have made on other message boards that you have been eating watermellon with your dieticians blessing, my advice on that would be to stop it immediately.

You should also be checked for GI bleeding which could also account for the elevation in your K.

As far as my background, I am the Chief Tech for a nonprofit foundation with 22 years of dialysis experience in both patient care and equipment. Before dialysis I was a paramedic.

[This message has been edited by Chuck W (edited 07-30-2002).]

Patient,

Chuck W. is most correct in his recent post to you. I've been a "Chief Technologist" for 20 years and a former U.S. Navy Transplant Technician/Hospital Corpsman. I can appreciate your dilemma regarding your trust in the clinical staff responsible for your care. Much of the unlicensed, and some of the licensed clinical work force have a poor "grass roots" level of dialysis and nephrology nursing. They may have learned recent technology but get stuck when troubleshooting because they lack sound training in theory and fundamentals.
You will find among the CT population, folks who have that knowledge. Hopefully your CT/Tech Manager can step in and help.
I'll teach ANYONE who wants to learn more about equipment and the clinics at large. Most CT's probably feel the same.

quote:

Originally posted by Patient:
Returning to the discussion of what I hope will soon be a tx problem solved. The machine I dialyze on is a FR 2008H. I'm a patient who believes in being part of my tx team. It would be nice if I could just sit back, let the staff run the tx, and take a nap. But I have never shut my eyes in dialysis, because I've never had a staff that was technically well trained. I did dialyze once in a hospital acute unit where I encountered a higher degree of knowledgeable staff. I could ask questions there and get accurate answers. I have found that it is to my advantage, anyway, to have to know how to run my tx. Its better to be alert and a part of the decision making for my care. I don't just have a little knowledge. I have a considerable amount of growing knowledge after studying dialysis everyday for 3 years.

At the point we're at now, I saw the doctor and told him that checking my K each tx with a local lab is the advice other medical people have given me. He disagrees and says that the once a week testing which is sent to a lab across the country is sufficicient. Otherwise, he says, I'll become anemic. But he said if I insist on going to a local lab independently he will refer me. Only thing is, I can't have my blood drawn at my unit through my access.. I'd have to have it drawn through my other arm which is a risk to a future access. He says we have no one from the unit to take it to a local lab???

So, I'm in a holding pattern until I get furthur advice. From everyone I've consulted with, the K should be checked with each tx in a case like this. I've had 5 txs thus far on a 1K, and the last across the country lab of 2 txs ago said my K had dropped only 1 point to 6.2. The 1K bath seems to have the effect of intensifying the fluid removal. It brings me a little too close to my dry weight, taking me to the point of .1 below my target goal. So, I have taken off .2 less and that has helped relieve my symptoms somewhat the last two txs. My doctor says the 1K bath should have no effect on me. But I have experienced it definitely does change the dynamics of the tx producing uncomfortable symptoms. I actually have a very nice staff that I like very much, but it doesn't change the fact that they need more training. Can I make them get training? I wish I could. Are you guys biotechs or pcts? I appreciate any techinical instruction very much.

Chuck,
I do not have time today to respond in full, but want to ask 2 questions: 1) with my K at supposedly 6.2, how quickly would you expect it to drop back into range with my dialyzing on a 1K bath? and 2) why does
GI bleeding increase K?

What?,
I have never once seen our CT. He's not available for patient education.

Patient,

If the cause of the elevated K is not taken care of then it will not drop back down to "normal".

With GI bleeding, the blood is essentialy destroyed in your GI tract which released the potassium in the cell which is in turn reabsorbed.

patient are treatments going better, you had complained cramps, chest pain, dementia, as well as your K level. Have the other symptoms eased? I tend to agree with Chuck that at your K it is not necessary to draw each treatment, however I think anemia is a lame excuse for not doing so.
As far as backgrounds I have been a chief tech/biomed tech for 16 years, and I have never turned down the opportunity to train patient care staff, nursing staff, or patient support groups on equipment theory and operation. I would frown on any with the attitude of not wanting to train. The more informed and alert everyone (including you) are the smoother more effective the treatment. Hope my thoughts have helped.