Phosphorous serum level . Indicate oral or IV replacement below Page 1 of 1 Please send a new protocol form to Pharmacy each time potassium replacement is needed. Algorithms for IV fluid therapy in adults *Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in a 24-hour period). The dose and administration IV infusion rate for potassium phosphates are dependent upon individual needs of the patient. Dextrose containing IV solution not recommended. Drug therapy / treatment options General notes. Guidelines for Electrolyte Replacement INTRAVENOUS POTASSIUM REPLACEMENT RECOMMENDATIONS FOR PATIENTS WITH NORMAL RENAL FUNCTION Serum potassium Recommended IV Recommended (mEq/L) KCl supplementation follow-up monitoring 3.5 - 3.9 20 mEq x1 dose Recheck serum potassium in 2 hours and with a.m. labs 3 - 3.4 20 mEq x4 doses Recheck serum potassium
Potassium Chloride 20 mEq PO every 2 hours for 3 doses. IV Preparations. Effervescent tablets (Sando-K ®), which each contain 12mmol of potassium and 8mmol of chloride, are preferable as modified release tablets (SlowK ®) may cause gastrointestinal ulceration.. 20mmol potassium chloride in 500ml sodium chloride 0.9% 20mmol potassium chloride in 500ml sodium chloride 0.9%/glucose 5% Maximum infusion concentration/rate: Peripheral: 20mmoL potassium in 500ml. Intravenous potassium chloride repletion may only be requested if the patient is NPO and/or otherwise unable to take any oral medications. Risk of Insulin induced exacerbation of Hypokalemia Dextrose containing IV solution not recommended. Continuous cardiac monitoring and infusion via a central venous catheter are recommended for infusion rates >10 meq potassium per hour. 15 mmol IV q6hrs PRN for serum Phos 1.5-1.9 mg/dl Infuse over 4-6 hours. When potassium level is still dangerously low despite already giving IV fluids with KCl at 60 meq/l., it is probably better to give intermittent bolus doses no more than 0.5 mEq KCl/Kg/hr until the serum K>3.0. The electrolyte replacement protocols, Magnesium Sulfate, or Potassium Chloride, may be ordered individually or in combination.
Phosphorous serum level 0.5-1 mg/dL: 0.25 mmol/kg IV infused over 4-6 hr
2 V. Phosphorus Replacement a. IV Sodium phosphate or Potassium phosphate (use sodium phosphate if K+ > 4.0 or renal insufficiency) i. potassium per hour; maximum infusion rate = 40 meq potassium per hour. • For PO/PT replacement: Neutra-Phos / Neutra-Phos K packets are no longer manufactured. Draw Phosphorus level 4 Hrs after last IV dose. Risk of Insulin induced exacerbation of Hypokalemia Hypophosphatemia. IV POTASSIUM REPLACEMENT: Serum Potassium Level Total Potassium Replacement Central Administration (Rate 20 mEq/hr) Peripheral Administration (Rate 10 mEq/hr) 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. Check serum [K]q 1-2 hours when using this replacement approach.
0.5 mg/dL: 0.5 mmol/kg IV infused over 4-6 hr. As a general rule, 10mEq of potassium given may increase serum potassium by 0.1. Recheck serum potassium level 4 hours after total dose is given and notify physician with results. IV Preparations. • Only the selected electrolytes will be replaced per protocol Notify physician if electrolyte deficiency does not correct after _____ doses. Once the hypokalemia is no longer severe, the IV should be reduced or stopped (continuing only with the oral therapy). Electrolyte Replacement Labs Draw Potassium level 2 Hrs after each IV dose or 4 Hrs after each Po dose Draw Magnesium level 4 Hrs after last IV dose. Electrolyte Replacement – Critical Care ICU/PCU [30400716] PHYSICIAN ORDERS PATIENT INFORMATION POTASSIUM LEVEL LESS THAN 2.2 (Single Response) ( ) potassium CENTRAL IV 40 mEq, IntraVENous, for 2 Hours, Every 2 hours, Starting today, For 2 Doses For Potassium level less than 2.2 mmol/L and notify MD if symptomatic. • Always look at potassium level to determine appropriate IV phosphorus product: use .
NEVER GIVE POTASSIUM AS BOLUS IV INJECTION. Intravenous Phosphate Replacement for Patients NOT receiving Parenteral Nutrition Serum Phosphate Level (mg/dL) mmol of Phosphate 2 to 3 10 mmol < 2 15 mmol Dilute in 150 ml 0.9% NaCl or D5W and infuse over 6 hours. • For IV replacement: Pharmacy will dilute in 250mL NS or D5W. Use 10 meq KCl IV in 50ml solution over 30 minutes minimum. If the patient’s potassium is < 3.9, administer as potassium phosphate (contains 3 mmol/mL of phosphate and 4.4 mEq/mL of potassium). INTRAVENOUS ADMINISTRATION . Rate of infusion = 10–20 meq potassium per hour; maximum infusion rate = 40 meq potassium … POTASSIUM)REPLACEMENT) Severity) Serum)Potassium)Concentration) IVPotassiumReplacementDose) Mild&to&Moderate& 2.5–&3.4& 20–&40mEq& Severe& <2.5& 40–&80mEq& aIn patients with normal renal function; patients with renal insufficiency should receive !50% of the initial empirical dose. Oral potassium chloride is the treatment of choice for most patients.