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Potassium Replacement
SURGICAL CRITICAL CARE
Electrolyte Replacement Practice Management Guideline
Phos ≤ 2.
Give KCl Give K Phos
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis, creatinine clearance <20, have active transfer orders out of the SICU, DKA, rhabdomyolysis
** Always look at phosphorus level to determine appropriate potassium product **
K < 4.
Phos > 2.
See Phos Protocol (additional KCl may be warranted)
Serum K+ Replace With Recheck Level
3.3-3.9 meq/L 40 meq KCl PO/PT/IV immediately after replacement
3.0-3.2 meq/L 60 meq KCl PO/PT/IV^
immediately and with next AM labs
2.6-2.9 meq/L 80 meq KCl IV and NHO immediately and with next AM labs
< 2.6 meq/L 100 meq KCl IV and NHO immediately and with next AM labs
*** 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.
- Serum potassium may be expected to increase by ~0.25 meq/L for each 20 meq IV KCl infused.
Approved: Dr. Addison K. May, MD, FACS, FCCM December 2013
Magnesium Replacement
SURGICAL CRITICAL CARE
Electrolyte Replacement Practice Management Guideline
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis, creatinine clearance <20, have active transfer orders out of the SICU
Serum Magnesium Replace With
1.6 – 1.9 mg/dL
4 grams IV over 2h -or- Magnesium oxide 250mg PO BID
1.0 – 1.5 mg/dL 6 grams IV over 3h
< 1.0 mg/dL 8 grams IV over 4h
IV Administration:
- Magnesium replacement will now be one-time doses.
- All doses will be comprised of the appropriate number of 2g/50mL premixed piggybacks. Infuse at a rate of 2gm per hour.
Oral Administration:
- Applies to patients with magnesium level > 1.5 mg/dL who are asymptomatic and able to tolerate PO or PT meds.
- ** Elemental magnesium (supplied as magnesium oxide) or Milk of Magnesia may be initiated; however, diarrhea may be a limiting factor. Separate order must be entered into Wiz/HEO for oral replacement.
Approved: Dr. Addison K. May, MD, FACS, FCCM December 2013
Calcium Replacement
SURGICAL CRITICAL CARE
Electrolyte Replacement Practice Management Guideline
EXCLUSIONS: Patients on hemodialysis/peritoneal dialysis,
creatinine clearance <20, have active transfer orders out of the SICU
Calcium replacement based upon ICa++^ levels
Ionized Calcium Replace With Recheck Level
3.5-3.9 mg/dL 4g CaGluconate With next AM Labs 3.0-3.4 mg/dL 6g CaGluconate 4 Hours After Replacement 2.5-2.9 mg/dL 8g CaGluconate 4 Hours After Replacement < 2.5 mg/dL 10 g CaGluconate NHO 4 Hours After Replacement Infuse 2gm per hour
Approved: Dr. Addison K. May, MD, FACS, FCCM
December 2013
Zaloga GP, K.R., Bernards WC, Layons AJ , Fluids and Electrolytes. Critical Care, ed. T.R. Civetta JM, Kirby P .Vol. 1. 1997, Philadelphia: Lippincott-Raven. 23.63.
Panello JE, Delloyer RP , Critical Care Medicine 2nd^ Edition 2002; St. Louis: Mosby, Inc. 1169 Polderman, et al. CCM 2000 June; 28(6) 2022- Polderman et al. J. Neurology 2001 May; 94(5): 697-
