Iv potassium replacement protocol (3) Check magnesium level (magnesium status can influence potassium homeostasis). The World Health Organization recommends a potassium intake DKA/HHS Potassium Replacement Scale Protocol Only Appears If: SB IP AND NON-ED PATIENTS Providers: Order DKA/HHS Potassium Replacement Protocol via the Diabetic Ketoacidosis (DKA) & Hyperglycemic Hyperosmolar State (HHS) Management Order Set. See acute renal failure for further management. Potassium replacement should be started after serum levels fall below 5 mEql/L (5 mmol/L) to maintain a potassium level of 4-5 mEq/L (4-5 mmol/L). Phosphorus Replacement ** Always look at phosphorus level to determine appropriate potassium product ** Always look at potassium level to determine appropriate IV phosphorus product: use Phos if K < 4. 5 mg/dL, enter orders for potassium replacement using potassium chloride (KCl) with lab monitoring provided in potassium replacement table below; If phosphorous level less than and equal The modified release forms of potassium (slow K), should be avoided at they possess a lower potassium content and have been associated with a risk of oesophageal ulceration. Potassium replacement protocol IWPO Potassium reolacement Ichoose IV or Hl_ll Oral potassium (tabs or packets) IV Potassium Repeat Potassium Magnesium IV for use With IV/PCI K+ Lidocaine IZ 4mI amp ORDERS Potassium Magnesium Creatinine DO NOT USE IF scr IS OR ON DIALYSIS ORAL ROUTE SHOULD BE USED UNLESS OR SYMP protocol Analgesics Antibiotics Prescribe IV potassium replacement, ensure any hypomagnesaemia is also corrected as this will assist in the retention of potassium. II. It lists exclusion criteria for each electrolyte and recommends replacement dosages based on serum levels. INTRAVENOUS POTASSIUM REPLACEMENT RECOMMENDATIONS FOR PATIENTS WITH NORMAL RENAL FUNCTION INTRAVENOUS MAGNESIUM REPLACEMENT RECOMMENDATIONS 2 - 2. Management of Hypokalaemia (plasma K + <3. Intravenous potassium chloride (KCl) repletion requires the approval of the attending neonatologist. The orders may not be appropriate for patients with ESRD, acute renal insufficie y induced hypertension Other IV Fluids select a different IV fluid If initial K < or = 3. ) potassium should be given, with close follow-up, continuous ECG monitoring, and serial potassium levels measurements. Routine, Until discontinued, Starting S, • HOLD Initiation of insulin doses if Potassium is LESS THAN 3. Clinical judgment always supersedes pathway recommendations Review all medications, fluids/elctrolytes and procedures for specific contraindications Definition: Metabolic anion-gap acidosis due to elevated serum ketones Jun 6, 2024 · CONTENTS Diagnosis Symptoms Causes Evaluation of cause Treatment Enteral magnesium IV magnesium Physiology: magnesium handling magnesium level physical examination Hyperreflexia. Diabetic Ketoacidosis (DKA) Two Bag System [3361] DKA: Blood glucose greater than 250 mg/dL, arterial or venous pH less than 7. 1 mEq per L (0. Potassium Replacement (Provider Driven Only) Always evaluate phosphorus level to determine appropriate potassium product. 5 mEq/kg/h Jan 19, 2025 · Potassium replacement can occur more slowly once the serum potassium level is persistently above 3 mmol/L or clinical symptoms have resolved. 1 mmol per L) is a great memory tool, it is not valid Potassium should never be added to IV fluid therapy unless one is sure that the patient is not in renal failure. 5 Meq/L. 5 mg/dL Phos 2. Please order doses accordingly. The underlying cause of hypokalemia should be identified and corrected. 0 mEq per L, respectively. K-Phos Neutral tablet is the formulary alternative. Jul 11, 2025 · The recommended dosing for intravenous potassium replacement in pediatric patients is 0. 0 mmol/L, replace Phos using POTASSIUM phosphate (KPhos) If serum potassium level is > 4. May 5, 2025 · Hypomagnesemia is a condition characterized by low magnesium levels, requiring evaluation and treatment to address underlying causes and restore balance. ECG manifestations Hypomagnesemia may prolong all intervals (PR, QRS, QT). 5 mEq/L (representing mild to moderate hypokalemia), may need only oral potassium replacement. Jul 4, 2024 · CONTENTS Rapid Reference Diagnosis ECG in hypokalemia ️ Interpretation of low potassium levels, symptoms, & risk stratification Causes Workup Sophisticated laboratory tests Treatment Target potassium level? Potassium pharmacology Enteral potassium IV potassium Magnesium repletion Other measures Physiology: Potassium pharmacokinetics Podcast Questions & discussion Pitfalls consider risk Potassium Replacement Before entering every potassium replacement order for potassium ≤ 3. Additional supplemental doses may be indicated. At the study institution, an institution-based, nurse-driven standardized electrolyte replacement protocol is used in critically ill patients with a serum creatinine concentration of 2 mg/dL or less. IV phosphate replacement will be in the form of sodium phosphate. or EN at goal. For those patients, increasing the potassium concentration of the maintenance IV fluids or TPN is usually sufficient. 0 mEq/L. When protocols are used to guide potassium replacement and other electrolytes, clear guidance as to the compulsoriness of the protocol is needed. A high-sodium diet often results in excessive urinary potassium loss. Hyperkalemia: check if sample was hemolyzed or sent off IV running potassium; if either is true, order stat plasma K and recheck if renal failure: patient may require immediate medical management and urgent dialysis Hyperkalemic emergency: DKA Potassium Replacement Scale Protocol [3364] Providers: Order DKA Potassium Replacement Protocol via the Diabetic Ketoacidosis (DKA) Order Set. Infuse over2-6 hours. , · Notify Less than or equal to 1 mg/dL 6 gm IV 1 to 1 4 gm IV 1 to 1 2 gm IV Potassium Replacement Protocol – Replace to 3 (For potassium bicarbonate PO, potassium chloride IVPB/PO) If serum Cr is greater than 2 or increases by 0 mg/dL since last draw, contact provider for new replacement orders K Level Now Dose Repeat Dose Recheck K Level Decreased intake of potassium Inadequate potassium replacement in IV fluids whilst nil by mouth, total parenteral nutrition (TPN), malnutrition. If the serum creatinine *** Consider PO/PT replacement if GI tract available *** If central line present and continuous cardiac monitoring, infuse at 20 mEq/hr (max = 40 mEq/hr); If peripheral access only, infuse at 10 mEq/hr. These are instituted upon direct physician order entryinto Sunrise XA. In a patient with simple potassium depletion, potassium replacement therapy should correct serum potassium concentration, but may have little effect when renal potassium clearance is abnormally increased from potassium wasting. Based on our findings, we developed and implemented a nursing-driven electrolyte replacement protocol. 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. All doses will be comprised of the appropriate number of 4 g/100mL premixed piggybacks. Oral replacement - potassium 20 mEq Feb 12, 2024 · INTRODUCTION Although hypokalemia can be transiently induced by the entry of potassium into the cells, most cases result from unreplenished gastrointestinal or urinary losses due, for example, to vomiting, diarrhea, or diuretic therapy [1-3]. Serum potassium may be expected to increase by ~0. Most common is prolonged QT interval, which may progress to Torsade de Pointes. K-Phos 1-2 tabs PO QID. ) The treatment and prevention of hyperkalemia will be reviewed here. 5–3. Important information Potassium chloride solutions can be FATAL if given inappropriately - administration must be by slow intravenous infusion through a pump. "NHO" on medical guidelines or protocols often stands for "Nursing Home-Outpatient. The severity of Hypokalemia Mild hypokalemia if K 3-3. If the serum Despite utilizing higher serum potassium concentration thresholds for replacement as well as higher maximum dosing than published literature, our protocol was effective at resolving hypokalemia, as defined by our protocol, without leading to significant hyperkalemia. potassium containing fluid is administered as necessary (see Guidelines for Prescribing Intravenous Fluids for A All potassium containing infusions must be given via an infusion pump and also a burette if greater than 10 mmol. Calcium Replacement (Provider Driven Only) Ionized calcium levels should be used to guide calcium repletion, as it is the metabolically active form of calcium and not affected by hypoalbuminemia. 6 mEq/L 20 mEq KCl PO/Per feeding tube Q2H x 2 doses No Mar 21, 2025 · From the Research Potassium Replacement Protocol The protocol for potassium replacement during treatment with Lasix (furosemide) involves monitoring serum potassium levels and adjusting treatment accordingly. General considerations 2. Dec 1, 2023 · Potassium replacement protocols are used to standardise practice, reduce risk, and ensure timely potassium replacement, but there is considerable variability in their development and use, particularly as part of critical care nursing practice. If patient is hypernatremic or hypokalemic, contact physician regarding possibly replacing as potassium phosphate instead. 5 mg/dL The electrolyte replacement protocols, calcium chloride (ICU/ED only) or calcium gluconate (all levels of care), magnesium sulfate, potassium chloride, or potassium phosphate, may be ordered individually or in combination. AGE) and consider checking labs more frequently (at least q 24 hours) in these patients. Corey Slovis) Repletion of magnesium is critical in repleting potassium. Recheck potassium STAT 1 hour after infusion completed. Always look at phosphorus level to determine appropriate potassium product. Feb 12, 2024 · INTRODUCTION Although hypokalemia can be transiently induced by the entry of potassium into the cells, most cases result from unreplenished gastrointestinal or urinary losses due, for example, to vomiting, diarrhea, or diuretic therapy [1-3]. Fl uid and electrolyte replacement in dialysis-requiring inpatients The usual principles apply – daily requirements = losses + approx 500ml (for insensible losses). Infuse over 4-6 hours. You don't just dump her out the hospital gates and that's it. Potassium Replacement (Provider Driven Only) A. Potassium Replacement Potassium replacement scale: HOLD INSULIN if potassium is LESS than 3. Gradual replacement of potassium (via oral route) is preferred, if clinically appropriate5 An ECG is strongly recommended in patients with severe/symptomatic hypokalaemia, cardiac disease or renal impairment5,6 Potassium must be replaced cautiously in patients with renal impairment (risk of hyperkalaemia secondary to impaired potassium excretion). However, ACE inhibitors can lead to lethal hyperkalemia in patients with renal insufficiency who are taking potassium supplements or potassium-sparing diuretics. 0 mmol/L, replace Phos using SODIUM phosphate (NaPhos) HOLD phosphorus replacement if serum sodium is < 128 mmol/L or > 155 mmol/L. 0 mEq/L potassium ∼ 0. from publication: Decreasing IV Potassium in Pediatric Cardiac Intensive Care: Quality Improvement Project | Objectives: IV potassium Central access allows for more rapid administration. 3 6 days ago · Navigating IV administration protocols is crucial. post-operation, coronary ischaemia, critical illness Re-feeding Pediatric Fluid and Electrolyte Management Elizabeth Byler, APRN, CNP-AC/PC Kalyn Seislove, APRN, CPNP-AC/PC Oral potassium can be prescribed in conjunction with IV potassium. Give 10-20 mmol of potassium in each liter of intravenous fluid as needed. Treat potassium per DKA potassium replacement protocol and contact prescriber for instruction on insulin initiation. Learn if and how you can give IV magnesium and potassium at the same time, including safety, compatibility, and best practices. 0 mEq/L Phos > 2. Calcium CHLORIDE provides 270mg elemental Ca++ per gram; Calcium GLUCONATE provides 90mg elemental Ca++ per gram. Jul 5, 2023 · NOTE: potassium should never be added to bolus IV fluids Deficit Replacement: Use isotonic fluid (0. All doses of sodium phosphate will be mixed in 100 ml of D5W and infused at a standard rate of 5 mmol/hr. Most institutions have protocols setting a maximum infusion rate (typically 20 mEq/ hour through a peripheral IV and 60 mEq/hour through a central line). Moderate hypokalemia if K 2. IV potassium should be used for patients who are unable to swallo Nov 1, 2025 · IV Preparations Potassium Chloride (KCl) 10 meq IV "K bump" Potassium Chloride (KCl) 20 meq use is limited to delivery via Central IV Access IV Replacement Algorithm Use 10 meq KCl IV in 50ml solution over 30 minutes minimum Dextrose containing IV solution not recommended Risk of Insulin induced exacerbation of Hypokalemia In select situations, may give up to 40 meq in 1 hr Example indication Electrolyte replacement protocols for K, Mg, Phos, Ca in surgical ICU. Standard Dosage Forms: Oral or Enteral: 1. 5. 33 mEq sodium 1 mMol potassium INTRAVENOUS POTASSIUM REPLACEMENT RECOMMENDATIONS FOR PATIENTS WITH NORMAL RENAL FUNCTION INTRAVENOUS MAGNESIUM REPLACEMENT RECOMMENDATIONS 2 - 2. You may also find these other videos in my FLUIDS & ELECTROLYT Mar 13, 2023 · Angiotensin-converting enzyme (ACE) inhibitors, which inhibit renal potassium excretion, can ameliorate some of the hypokalemia that thiazide and loop diuretics can cause. Be aware of other potassium containing fluids running i. 5 mEq per L or greater than 5. 5 mg/dL Feb 5, 2024 · Many of these patients have a significant deficit in whole body potassium and must be monitored carefully for the development of hypokalemia during therapy. 0 and Na Phos if K ≥ 4. theophylline), diuretics, catecholamines (e. m. g. May increase risk of various other arrhythmias (especially Aug 12, 2025 · Protocol for Electrolyte Replacement in Patients with Electrolyte Imbalances Electrolyte replacement therapy should be guided by the specific electrolyte deficiency, underlying cause, and patient's clinical status, with prevention strategies prioritized over reactive supplementation whenever possible. Dosage, administration guidelines. High strength versus ready-to-use High strength potassium chloride solutions are defined as 10% potassium chloride (1gram potassium in 10ml) or more. 3, serum bicarbonate less than 15 mEq/L anion gap greater than 12 and ketonuria or ketonemia. 5 mg/dL, enter orders for potassium replacement using potassium chloride (KCl) with lab monitoring provided in potassium replacement table below; Mar 21, 2025 · From the Research Potassium Replacement Protocol The protocol for potassium replacement during treatment with Lasix (furosemide) involves monitoring serum potassium levels and adjusting treatment accordingly. 1 mMol sodium phosphate = 1. 9% NS) for fluid deficit replacement / boluses *Use caution in patients receiving large volumes of IV fluids for deficit replacement (e. Potassium phosphate is not included in this protocol Fluid Administration, Continuous IV, Inpatient Inpatient Clinical Pathway for Children Who Require Continuous Administration of IV Fluids Goals and Metrics Out-of-scope Locations PICU, N/IICU, CICU, CCU, Day Medicine Out-of-scope Conditions Heart failure Parenteral Nutrition Hypoglycemia Suspected Metabolic Disease Confirmed SIADH DKA Diabetes Jan 24, 2024 · If both PO and IV potassium replacement is ordered, the PO replacement will be utilized as first line unlessany of the following are true: the patient cannot take medications orally or via feeding tube or the patient refuses PO replacement. Notify physician. Aug 14, 2024 · require immediate correction of potassium blood levels. Magnesium supplementation “HypoK = HypoMg” (a mantra from Dr. "The objective of this study was to evaluate the occurrence of low serum potassium and magnesium, and identify the rate of replacement for patients with low serum potassium and magnesium levels" Ajewole et al (2020). Nursing Interventions for pain related to Infusion of IV Potassium Interventions for pain relief related to IV Potassium Infusion 100% 90% 80% 0% 10% 20% 30% 40% 50% 60% 70% adjusted rate applied ice pack elevated extremity pre medicated pre-protocol ** IV potassium phosphate contains aluminum; use only in the setting where sodium phosphate is undesirable based on laboratory results. For PO/PT replacement: Neutra-Phos / Neutra-Phos K packets are no longer manufactured. ELECTROLYTE ORDERS SHOULD BE Dec 15, 2021 · CONTENTS Potassium homeostasis Internal distribution of potassium Kidney potassium handling Pathophysiology Clinical manifestation Diagnosis Red flags Causes of hypokalemia Investigation Treatment Potassium replacement Oral IV Other therapeutic measures Disposition Further going Reference Potassium homeostasis Potassium is the main intracellular cation and almost all cells have the pump called Persistent hypokalemia may reflect total body potassium depletion or increased renal potassium clearance. Preferred Choice Over K Phos Rechecking After Replacement: Wait 2-4 Hours Enteral Dosing: Variable Bioavailability – Dose Should Be Tripled 250 mg PO is Equivalent to 8 mmol Generally Given in 3-4 Doses Over the Day Potassium Phosphate (K Phos) Same Correction as Na Phos Also Provides 22 mEq K per 15 mmol Magnesium Replacement (IV preferred) - If both serum magnesium and potassium levels are low, initiate magnesium replacement for 1 hour prior to potassium repletion. Potassium Level (mEq/L) Potassium Chloride Dose Monitoring LESS than or EQUAL to 3. amiloride). Low Potassium (< 3 mmol/L) and Phosphate (< 1. Electrolyte replacement Hypokalemia and hyperkalemia occur when serum potassium levels are less than 3. 5mmol/L) Assessment / monitoring Plasma potassium General management Replace potassium losses Identify and treat underlying cause where possible: Loop / thiazide diuretics - consider combination with a potassium-sparing diuretic Vomiting and diarrhoea Intracellular potassium shifts, e. 5 mEq/L, intravenous (i. 5-3 Meq/L. If peripheral access only, inf KPhos and KCl IV should never be infused at the same time. by infusion pump/rate control devices. Oral Phosphate Replacement Oral repletion is most often achieved with a combined preparation of sodium and potassium phosphate. Regardless of severity, careful serum potassium level monitoring is required, as hyperkalemia commonly develops in hospitalized patients. Alternately, with safety a priority, when and how clinicians may use their clinical judgement and discretion in potassium replacement must also be explici … Hypokalemia in children: causes, symptoms, diagnosis, and treatment options discussed comprehensively for better understanding and management. 5 mg/dL) When potassium and phosphate are both low, utilizing IV potassium phosphate replacement can decrease the amount of electrolyte replacement products required Goal potassium level: 3. Jan 29, 2021 · Acute kidney injury (AKI) (acute renal failure, ARF) Prompt resuscitation can restore blood pressure and renal perfusion in the majority of patients with acute renal failure. 9, review phosphorous level to determine which potassium product to administer: If phosphorous level greater than 2. TPN Sep 26, 2022 · Common potassium replacement products 1st-line: potassium chloride 2nd-line: Potassium phosphate: usually reserved for patients with hypokalemia AND hypophosphatemia Potassium acetate: usually reserved for patients with hypokalemia AND metabolic acidosis (e. IV. If the replacement cannot be completed according to the protocol, contact the prescriber for clarification. Severe or critical if K < 2. The goal of the Council was to assess the role of potassium in terms of current medical practice and future clinical applications. Clinical Guidelines Summary This guideline is for use in children on ward 19/20 University Hospital Wishaw who have been identified as having low potassium and have failed to correct with oral supplementation alone or peripheral intravenous fluids with potassium supplementation, where the concentration of potassium given was 20mmol/500ml bag of IV fluids. (See "Diabetic ketoacidosis in adults: Treatment", section on 'Potassium replacement'. Either potassium phosphate or sodium phosphate injection may be used for IV phosphate replacement. Electrolyte disturbances may develop in patients during normal care. 3 mEq/L. v. Apr 1, 2021 · In critically ill patients, maintaining appropriate serum potassium concentrations requires careful supplementation to correct hypokalemia but avoid hyperkalemia. Consider the patient’s comorbidities, organ dysfunction, and concurrent drug therapy before ordering electrolyte supplementation. For IV replacement: Pharmacy will dilute in 250-300mL NS. If patient has a working GI tract (if patient receiving oral medications/feeds or has OG tube and receiving feeds and/or medications) replace orally with Always look at potassium level to determine appropriate IV phosphorus product: use Phos if K < 4. Potassium (K+) Replacement In renal insufficiency give 50% of normal dose Greater reductions in potassium dose may be necessary if patient is anuric When serum K+ < 3. Transcellular shift Alkalosis, insulin and glucose administration, β2 sympathomimetics (e. Potassium replacement is recommended for individuals who are subject to nausea, vomiting, diarrhoea, bulimia, or diuretic/laxative abuse. Mar 4, 2020 · Study objective: The objective of this study was to evaluate the occurrence of low serum potassium and magnesium, and identify the rate of replacement for patients with low serum potassium and magnesium levels. See BWH NICU DAG page for more details. , renal tubular acidosis, diarrhea) Treatment of Hypokalemia 20 mEq, intravenous, for 60 Minutes, every 1 hour, For 2 Doses For Central Line Only; Recheck level 1 hour after the end of IV administration and reapply orders if needed. Dec 9, 2019 · The potassium calculator was designed to enable the safe administration of potassium replacement as in intermittent infusion (often incorrectly called a ‘bolus’) addressing the problems of pain at the intravenous insertion site, risk of extravasation injury, the type of intravenous access (central versus peripheral) and considering the rate and amount of potassium administration from all Feb 1, 2019 · Conclusion In critically ill patients given potassium replacement without regard to a formal protocol, the target serum potassium concentration was achieved more often than expected according to the rule-of-thumb estimation but less than one-third of the time. 25 mEq/L for each 20 mEq IV KCl infused. ICU Electrolyte Protocol with AGGRESSIVE Magnesium Replacement [1425] ICU Electrolyte Protocol with AGGRESSIVE Magnesium Replacement [1425] These orders are intended for the treatment of electrolyte depletion in ADULTS. The primary outcome of the meeting was the development of guidelines for potassium replacement therapy. These are instituted upon the written order of a physician. For healthcare professionals. ) Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a Suggested Protocols for IV supplementation of Phosphate, Magnesium, Potassium and Calcium Notes: Replacement of electrolytes via IV piggyback infusion must be protected from IV fluid free flow e. 9 mEq/L 20 mEq KCl PO/Per feeding tube x 1 dose No additional action<br /> 3. Call provider with result. Infuse at a rate of 1 gm per hour. Rarely, more rapid potassium repletion through intravenous administration may be necessary. E. 9, review phosphorous level to determine which potassium product to administer: If phosphorous level > 2. ) Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a IV. 1 Assessment and Diagnosis Volume Depletion Assessment For volume depletion due to vomiting Sando K- 2 tablets TDS Consider IV replacement if patient does not tolerate PO replacement or already having IVI- initial IV dose of 40mmol/L potassium chloride Consider and treat causes for hypokalaemia Replace magnesium if low Monitor U&Es daily unless review date documented in patient notes or drug chart e. Jun 9, 2021 · ICU Electrolyte Replacement Protocol*Maximum infusion rate = 7 mmol phosphate/hour. 0 mEq/kg per dose, administered at a maximum rate of 0. Oct 11, 2023 · Aldosterone potentiates sodium/potassium exchange at renal distal tubules causing potassium excretion into urine Large loads of potassium delivered by IV fluids, TPN, IV medications with a high potassium content (eg, potassium penicillin), or massive blood transfusions can result in hyperkalemia Apr 1, 2021 · Abstract Background: In critically ill patients, maintaining appropriate serum potassium concentrations requires careful supplementation to correct hypokalemia but avoid hyperkalemia. 0 mmol/L should have cardiac monitoring, as should those receiving IV replacement Specialist advice should be sought for critical (K <2. Pediatric Floor Enteral Electrolyte Replacement This guideline provides suggested management of enteral electrolyte replacement therapy in hospitalized pediatric patients admited to the Pediatric Acute or Intermediate Care Units. Avoid use in patients with nausea, vomiti se at 20mEq/hr. Potassium chloride has been shown to be the most effective means of replacing acute potassium loss. These are instituted upon direct physician order entry into Sunrise XA. Replacement is primarily through IV administration, though oral or tube feeding is preferred for asymptomatic magnesium deficiency. For IV replacement: Pharmacy will dilute in 250mL NS or D5W. 0 mmol/L) or symptomatic hypokalaemia Background Nursing Protocols [ ] Electrolyte replacement protocol - Potassium [ ] Electrolyte replacement protocol - Magnesium [ ] Electrolyte replacement protocol - Phosphate re intended for the treatment of electrolyte depletion in ADULTS. If potassium levels are less than 2. Sign, fax and printable from PC, iPad, tablet or mobile with pdfFiller Instantly. 1 PRESCRIBING Consider commencing IV potassium replacement only when the oral route is unavailable or will not achieve the required elevation of serum potassium within a clinically acceptable timeframe. Fill Iv Potassium Replacement, Edit online. ‘review in 3 days’ Jul 18, 2025 · Comprehensive guide on maintenance and replacement fluid therapy in adults, covering indications, types, and administration methods. Recheck in a. However, the traditionally taught formula that 10 mEq per L of intravenous potassium replacement increases serum potassium by 0. " However, in the context of this potassium replacement protocol, it doesn't seem to fit. Sep 12, 2025 · Enter the desired potassium level, current potassium level, and the patient's weight into the calculator to determine the amount of potassium needed for replacement. In neonates enteral administration is often not possible. 5 mEq/L. BACKGROUND When potassium replacement is necessary, the enteral route of administration is preferred. Potassium replacement protocol Table1: Intravenous Potassium Replacement Repeat serum potassium level 4 hours after last dose of Potassium infusion. adrenaline), refeeding syndrome. It’s diluted in 250 ml of Normal saline. Thus, one should have a serum creatinine and be sure that the patient is voiding prior to the institution of potassium therapy. The electrolyte content of each of these products is outlined below. SURGICAL CRITI CAL CARE Electrolyte Replacement Practice Management Guideline K < 4. Serum potassium may be expected to increase by ~0. 5 Meq/L or any hypokalemia with symptoms. Treat potassium per DKA/HHS potassium replacement protocol and initiate/resume insulin only once potassium is GREATER THAN 3. 5-1. In Standing electrolyte replacement protocols are available for use in adult patients admitted to Orlando Healthhospitals. Phos NaK 250-500 mg 1 tab four times a day with meals and at bedtime. Once volume depletion has been corrected one can then go back to simple maintenance fluids as described Dec 2, 2017 · Potassium Phosphate 15 or 30 mmol IV over 4-6hrs can also be used to replace phosphorus IV if potassium is also low as well. 4 20 mEq x8 doses Recheck serum potassium and magnesium 2 hours after the 6th dose then give 7th and 8th dose, if needed. We would like to show you a description here but the site won’t allow us. A separate order will be needed for potassium phosphate. 9% as fluid of choice for initial replacement (unless contraindicated) as Glucose may cause a further decrease in plasma potassium levels (ref 1) Methods of intravenous administration The electrolyte replacement protocols, calcium chloride (ICU/ED only) or calcium gluconate (all levels of care), magnesium sulfate, potassium chloride, or potassium phosphate, may be ordered individually or in combination. Magnesium replacement will be one-time doses. Patients treated with furosemide are at risk of developing hypokalemia, which can lead to muscle cramps, weakness, and other symptoms 4. Children with an initial serum potassium <3. ***This Order Set is for Nursing utilization related to potassium replacement*** Potassium Replacement Potassium replacement scale for DKA patients: HOLD INSULIN if potassium is LESS than 3. Oct 7, 2025 · The maximum infusion rate of potassium chloride should not exceed 10–20 mEq/L per hour in a peripheral IV or 40 mEq/L per hour in a central line. Post-replacement monitoring frequencies vary The tiered-dosed, nurse-driven K<sup>+</sup> replacement protocol was associated with decreased supplemental K<sup>+</sup> doses without increased risk of hyperkalemia, administering doses faster than individually ordered doses; the protocol was effective, safe, and timely in the treatment of hypoka … Purpose: Provide standardization in the electrolyte replacement of patients admitted to the Vanderbilt Burn Center. 3 mEq/L Patients tolerating oral feeding and not symptomatic should receive oral replacement. e. Per protocol all intravenous doses will be replaced as sodium phosphate. salbutamol), phosphodiesterase inhibitors (e. The protocols are listed below. † Use discretion with potassium repletion in setting of renal impairment Implementation Date: Review Period: Hypokalemia treatment consists of two arms: Treatment of the underlying cause Potassium replacement therapy Potassium can be replaced orally/ enterally or intravenously. Phosphorus Replacement (PO preferred) Phos if K < 4. 7,8 The rate of administration should always be specified on the prescription: See under ‘Administration of Intravenous Potassium’ section below. (See "Causes of hypokalemia in adults". [1] Monitor fluid status and electrolytes in all children receiving potassium replacement. Effects of potassium-enriched salt substitutes on blood pressure in Iranian hypertensive patients: the protocol for a randomised, double-blind controlled trial. 0. 8 – 5 mmol/L Goal phosphate level: 3 – 4. Covers IV and oral administration, dosing, and critical monitoring to prevent complications. V. Therapeutic goals Target serum potassium level: ∼ 4. About the stable elderly lady, there are protocols in place for PO potassium replacement and GP follow up and what not. Electrolyte Replacement Labs Draw Potassium level 2 Hrs after each IV dose or 4 Hrs after each Po dose We would like to show you a description here but the site won’t allow us. 5 – 3. 5 mg/dL Give KCl Give K Phos See Phos Protocol Feb 3, 2023 · This video explains important safety considerations for intravenous (IV) potassium replacement. PHOSPHORUS REPLACEMENT PROTOCOL: If serum potassium level is < 4. Standing electrolyte replacement protocols are available for use in adult patients admitted to Orlando Regional Healthcare hospitals. The suggested electrolyte replacement doses may not be appropriate in all patients. Choice of intravenous potassium replacement Consider the following when you are choosing IV potassium products. Sodium Chloride 0. (arrhythmias, marked muscle weakness, or Low Potassium (< 3 mmol/L) and Phosphate (< 1. 3 mEq/L Patients tolerating oral feeding and not CRRT Electrolyte Replacement [1175] IV Fluids Medications Calcium IV - For Non ACD or Drip Patients (Single Response) Caution: Calcium Salts are not directly interchangeable on a mg per mg basis. Try Now! Patients with potassium levels of 2. 1 Nov 23, 2014 · POTASSIUM REPLACEMENT PROTOCOL – ORAL or ENTERAL (PT)<br /> • Standard dosage forms: KCl 20mEQ tablet or KCl 10% solution (20 mEq/15 mL)<br /> Current Serum<br /> Potassium Level<br /> Total Potassium Replacement<br /> Monitoring<br /> 3. (3)(5)(6) Choose the appropriate replacement form as follows: grind slow-release tablets) whenever possible. ( ) Diabetic Ketoacidosis (DKA), Patient is ESRD (Selection Required) [X] Notify (Selection Required) [X] Notify Provider Routine, Until Discontinued, Starting Today, At: N, · Do NOT initiate or continue insulin if potassium is LESS THAN 3. Potassium Replacement Before entering every potassium replacement order for potassium ≤ 3. Increased loss Via the kidney Medical protocol for electrolyte replacement (K+, Mg2+, Phosphorus) including orders, monitoring, and contraindications. 1 mEq/L 10 mEq Route of replacement hypokalemia severity, symptoms, and ability to tolerate/absorb oral medication Oral supplementation is typically preferred, due to a Excessive skin excretion of potassium due to excess sweating without adequate electrolyte replacement, burns or other dermatological conditions particularly affecting large areas of the skin. Extreme caution should be exercised in providing potassium replacement in any patient taking potassium-sparing agents (e. Summary Standing electrolyte replacement protocols are available for use in the adult intensive care units. Infuse UNIVERSITY HOSPITALS OF CLEVELAND ADULT ELECTROLYTE REPLACEMENT GUIDELINES The purpose of this guideline is to standardize the replacement of electrolytes within UHC. Sep 16, 2025 · Low potassium with weakness or U-waves? Use this NGN-ready hypokalemia care plan to correct K⁺ safely, fix magnesium, prevent dysrhythmias, and teach prevention. This document provides an electrolyte replacement protocol for calcium, magnesium, potassium, and phosphorus. 9% with potassium 20mmol per 500ml (B1983) may be used if potassium concentrate is being added to an infusion bag Use Sodium Chloride 0. 3 mEq/L, place order and begin potassium replacement PRIOR to initiating insulin infusion (to avoid precipitating dysrhythmias or cardiac arrest) Download scientific diagram | Potassium protocol. A combination of enteral and parenteral replacement may be utilized In situations where multiple enteral doses are required, the doses will be administered every 4 hours to decrease GI discomfort. 3 mmol/L, correct potassium BEFORE giving insulin by administering 10 mEq of KCL over 1 hour. 0 mEq/L and Na Phos if K 4. 7 – 3. While Pharmacy is responsible for any adjustments to the protocol due to drug shortages, sodium phosphate is the preferred IV phosphorus replacement per this guideline. This is often in patients Nov 16, 2025 · Learn the essential clinical protocols for how to give potassium protocol safely. If serum potassium level > 3 mEq/L and the patient is able to tolerate a diet, enteral administration is preferred. szi zjfrb qhgly rxyvtp icimm tosbgm jtku zdxi vhrl ybxg ljoxie pxzpzq gbrsh lewugcnq uspac