Potassium and ACE Inhibitors
The longer I live, the more I realize how important the simple things in life are. Communication whether in your personal life or in your work is so important. Here’s a great example of a missed opportunity due to ineffective or inadequate communication. Some labs were drawn on a patient that revealed an elevated potassium. The fax was sent to the physician from a nursing home. The provider noted the potassium to be at 5.9 (normal range 3.5-5.1 depending upon lab) and asked the question “Are they on any potassium supplements?” and sent the fax back. The nurse responded with “no”. They weren’t on a potassium supplement, but they were on an ACE Inhibitor (lisinopril, enalapril, ramipril etc.), a very common cause of hyperkalemia. Had the nurse been a little stronger clinically, or been able to pay a little closer attention to the med list, they could’ve been able to prevent the possible unnecessary use of Kayexalate. The physician should’ve had more time to look into the medication list as well, but we don’t live in a perfect world all the time. Maybe more importantly had the attending physician asked a different, more specific question it would have prompted the nurse to look a little more closely as well.