Nurse Tristan is caring for a male client with acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
A. Hypernatremia.
B. Hypokalemia.
C. Hyperkalemia.
D. Hypercalcemia.
Correct Answer: C. Hyperkalemia.
Hyperkalemia is a common complication of acute renal failure. It’s life-threatening if immediate action isn’t taken to reverse it. The administration of glucose and regular insulin, with sodium bicarbonate, if necessary, can temporarily prevent cardiac arrest by moving potassium into the cells and temporarily reducing serum potassium levels.
Option A: Hypernatremia is believed to be due to post-acute kidney injury diuresis in the face of inability to maximally concentrate the urine because of renal failure. The diuresis caused a disproportionate loss of water in excess of that of sodium in the absence of replenishment of the water loss.
Option B: Hypokalemia is related to increased use of diuretics, decreased use of RAS blockade, and malnutrition, all of which may impose additive deleterious effects on renal outcomes.
Option D: Hypocalcemia is a frequent accompaniment of acute renal failure, but paradoxically hypercalcemia also has been described in association with acute renal failure. This may be caused by dissolution of dystrophic calcifications in traumatized muscle and may lead to severe metastatic calcifications.