Table of Contents

ELECTROLYTE REPLACEMENT

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