Electrolyte Replacement

Topics: Calcium metabolism, Potassium, Sodium Pages: 5 (1085 words) Published: August 25, 2013
ADULT ELECTROLYTE REPLACEMENT PROTOCOLS
Standing electrolyte replacement protocols are available for use in adult patients admitted to King Khaled Hospital. Najran, Saudi Arabia. The protocols are listed below.
SPECIFIC REQUIREMENTS:
• Intravenous infusions of electrolytes must be administered with free-flow protected infusion devices (i.e. infusion pump). • Patients must meet the following criteria prior to initiation of the Potassium, Magnesium, or Phosphorus protocols:

o SCr < 2 mg/dL
o Weight > 40 kg
• The electrolyte replacement protocols, Calcium chloride (Level I areas only) or Calcium gluconate (all levels of care), Magnesium sulfate, Potassium chloride, or Potassium Phosphate, may be ordered individually or in combination. POTASSIUM REPLACEMENT PROTOCOL – INTRAVENOUS

• Recommended rate of infusion is 10 mEq/h
• Maximum rate of intravenous replacement is 20 mEq/h with continuous ECG monitoring (the maximum rate may be increased to 40 mEq/h in emergency situations) • Standard Concentrations: 10 mEq/50 mL, 10 mEq/100mL, 20 mEq/50 mL and 20 mEq/100 mL o Maximum Concentration for Central IV administration = 20 mEq/50 mL o Maximum Concentration for Peripheral IV administration = 10 mEq/50 mL |Current Serum Potassium Level |Central IV Administration |Peripheral IV Administration |Monitoring | |3.6 – 3.9 mEq/L |20 mEq IV over 2 HR x 1 |10 mEq IV over 1 HR x 2 |No additional action | |3.4 – 3.5 mEq/L |20 mEq IV over 2 HR x 1 |10 mEq IV over 1 HR x 3 |No additional action | | |AND | | | | |10 mEq IV over 1 HR x 1 | | | |3.1 – 3.3 mEq/L |20 mEq IV over 2 HR x 2 |10 mEq IV over 1 HR x 4 |Recheck serum potassium level 2| | | | |hours after infusion complete | |2.6 – 3 mEq/L |20 mEq IV over 2 HR x 2 AND |10 mEq IV over 1 HR x 5 |Recheck serum potassium level 2| | |10 mEq IV over 1 HR x 1 | |hours after infusion complete | |2.3 – 2.5 mEq/L |20 mEq IV over 2 HR x 3 |10 mEq IV over 1 HR x 6 |Recheck serum potassium level 2| | | | |hours after infusion complete | |< 2.3 mEq/L |Call Physician AND |Call Physician AND |Recheck serum potassium level 2| | |20 mEq IV over 2 HR x 3 |10 mEq IV over 1 HR x 6 |hours after infusion complete | |• If both potassium and phosphorus replacement required, subtract the mEq of potassium given as potassium phosphate from total| |amount of potassium required. (Conversion: 3 mmols KPO4 = 4.4 mEq K+) | |• Call pharmacy for assistance if needed. |

POTASSIUM REPLACEMENT PROTOCOL – ORAL or ENTERAL (PT)
• 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 mEq/L |20 mEq KCl PO/Per feeding tube x 1 dose |No additional action | |3.5 – 3.6 mEq/L |20 mEq KCl PO/Per feeding tube Q2H x 2 |No additional action | | |doses After last oral dose | | |3.3 – 3.4 mEq/L |20 mEq...
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