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shared:renal:electrolytes

Table of Contents

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
shared/renal/electrolytes.txt · Last modified: 2019/12/12 01:56 by 127.0.0.1