====== ELECTROLYTE REPLACEMENT =======

Derived from http://www.surgicalcriticalcare.net/Guidelines/electrolyte_replacement.pdf

===== Potassium =====

==== Intravenous ====

Do not exceed 10 mEq/h normally, 20 mEq/h with continuous EKG monitoring, 40 mEq/h in emergencies

^ Current Serum Potassium Level ^ Central IV Administration ^ Peripheral IV Administration ^ Monitoring ^
| 3.6 – 3.9 | 20 mEq IV over 2 HR x 1 | 10 mEq IV over 1 HR x 2 | No additional action |
| 3.4 – 3.5 | 20 mEq IV over 2 HR x 1 \\ AND \\ 10 mEq IV over 1 HR x 1 | 10 mEq IV over 1 HR x 3 | No additional action |
| 3.1 – 3.3 | 20 mEq IV over 2 HR x 2 | 10 mEq IV over 1 HR x 4 | Recheck 2 hours after infusion |
| 2.6 – 3 | 20 mEq IV over 2 HR x 2 \\ AND \\ 10 mEq IV over 1 HR x 1 | 10 mEq IV over 1 HR x 5 | Recheck 2 hours after infusion |
| 2.3 – 2.5 | 20 mEq IV over 2 HR x 3 | 10 mEq IV over 1 HR x 6 | Recheck 2 hours after infusion | 
| < 2.3 | 20 mEq IV over 2 HR x 3 | 10 mEq IV over 1 HR x 6 | Recheck 2 hours after infusion |

==== Oral or Enteral  ====

  * Standard dosage forms: KCl 20mEQ tablet or KCl 10% solution (20 mEq/15 mL)

^ Current Serum Potassium Level ^ Total Potassium Replacement ^ Monitoring ^
| 3.7 – 3.9 | 20 mEq KCl PO/Per feeding tube x 1 dose | No additional action |
| 3.5 – 3.6 | 20 mEq KCl PO/Per feeding tube Q2H x 2 doses | No additional action |
| 3.3 – 3.4 | 20 mEq KCl PO/Per feeding tube Q2H x 3 doses | Recheck 4 hours after last oral dose |
| 3.1 – 3.2 | 20 mEq KCl PO/Per feeding tube Q2H x 4 doses | Recheck 4 hours after last oral dose |
| < 3.1 | 20 mEq KCl PO/Per feeding tube Q2H x 4 doses | Recheck 4 hours after last oral dose |

===== Magnesium =====

  * Infusions should be no faster than 1gm of magnesium sulfate every 30 minutes.
  * Standard Concentrations: 1 gm/100 mL and 2 gm/50 mL 

^ Current Serum Magnesium Level ^ Total Magnesium Replacement ^ Monitoring ^
| 1.5 – 2 | 2 grams Magnesium Sulfate IV over 1 HR | No additional action |
| 0.9 – 1.4 | 2 grams Magnesium Sulfate IV over 1 HR x 2 doses | Recheck 2 hours after infusion complete |
| < 0.9 | 2 grams Magnesium Sulfate IV over 1 HR x 2 doses | Recheck 2 hours after infusion complete |

===== Phosphorus =====

  * Replacement must be ordered in mmol of phosphorus.
  * Recommended rate = 3mmol/hr (= 4.4 mEq/h of K)
  * Maximum rate = 10 mmol/hr (= 15 mEq/h of K)
  * Use SODIUM phosphate for patients with serum potassium > 4.5 and serum sodium < 145
  * Standard Concentrations:
    * Potassium Phosphate: 15 mmol/250 mL and 21 mmol/250 mL
    * Sodium Phosphate: 15 mmol/250 mL, 21 mmol/250 mL, and 30 mmol/250 mL
    
^ Current Serum Phosphorus Level ^ Total Phosphorus Replacement ^ Monitoring ^
| 2 – 2.5 mg/dL | 15 mmol Potassium Phosphate IV over 4 HR | No additional action |
| 1 – 1.9 mg/dL | 21 mmol Potassium Phosphate IV over 4 HR | Recheck 2 hours after infusion complete |
| < 1 mg/dL | 15 mmol Potassium Phosphate IV Q2H x 2 doses | Recheck 2 hours after infusion complete |

===== Calcium =====
  * Calcium chloride:
    * Central line required
    * Maximum 1 gm IV over 10 mins
    * Available as 1 gm/50 mL, 2 gm/100 mL, 3 gm/150 mL
  * Calcium gluconate
    * Central line preferred
    * Maximum 3 gm IV over 10 mins
    * Available as 1 gm/50 mL, 2 gm/100 mL
    
^ Current Ionized Calcium Level ^ Total Calcium GLUCONATE Replacement ^ Total Calcium CHLORIDE Replacement ^ Monitoring ^
| 1 – 1.1 | 1 gram IV over 1 HR | 1 gram IV over 1 HR | No additional action |
| 0.85 – 0.99 | 2 grams IV over 1 HR | 2 grams IV over 1 HR | Recheck 2 hours after infusion complete |
| < 0.85 | 2 grams IV over 1 HR | 3 grams IV over 1 HR | Recheck 2 hours after infusion complete |