ICU Electrolyte Replacement Protocol
exp date isn't null, but text field is
Adult Intensive Care Unit Electrolyte Dosing Guidelines
WARNINGS AND PRECAUTIONS
- Patients with renal insufficiency are exempt from these guidelines (e.g., serum creatinine ≥ 2 mg/dL, or patients on any form of renal replacement therapy (intermittent or continuous)).
- These guidelines are meant to assist with empiric dosing of electrolytes for ICU patients; doses may need to be adjusted based on patient-specific factors and responses to initial doses.
- Goal serum concentrations may also need to be adjusted based on patient-specific factors.
- These guidelines are for routine supplementation of electrolytes; they are not meant for treatment in urgent or emergent situations.
POTASSIUM
Goal serum potassium concentration 4.0 – 5.0 mEq/L
Treatment of Hypokalemia
*RN to decide route based on available access.
Any dose above 20 mEq may be administered as a combination of oral & intravenous.
|
Serum potassium concentration |
Intravenous potassium dose† Max IV is 20 mEq/hour |
Oral potassium dose |
Recheck serum potassium concentration |
|
3.8 – 3.9 mEq/L |
20 mEq IVPB |
20 mEq (1 packet) |
Within 2-4 hours of completing dose |
|
3.5 – 3.7 mEq/L |
40 mEq IVPB |
40 mEq (2 packets) |
Within 2-4 hours of completing dose |
|
3.2 – 3.4 mEq/L |
60 mEq IVPB |
60 mEq (3 packets) |
Within 2-4 hours of completing dose |
|
< 3.1 mEq/L |
80 mEq and notify MD |
80 mEq (4 packets) and notify MD Must be administered in combination with IV |
Immediately after completing dose |
|
† Rate of Intravenous Potassium Infusion |
10 mEq potassium/hour; can increase to 20 mEq/hour, but continuous cardiac monitoring and infusion via a central venous catheter are recommended for infusion rates > 10 mEq potassium/hour. Maximum of 40 mEq potassium/hour in emergency situations. |
|
Maximum Potassium Concentration |
80 mEq/L via a peripheral vein; up to 120 mEq/L via a central vein (admixed in NS or ½ NS) |
**Consider adding scheduled oral potassium chloride as indicated**
CALCIUM
Goal serum ionized calcium concentration 1.12 – 1.3 mmol/L
Treatment of Hypocalcemia
Oral treatment preferred when possible.
IV treatment preferred whenever patient is symptomatic.
|
Serum ionized calcium concentration |
Oral Calcium Citrate dose |
Intravenous Calcium Gluconate dose |
Recheck serum calcium concentration |
|
1.05 – 1.11 mmol/L |
2 tablets |
1 g over 30 – 60 minutes |
With next AM lab draw |
|
0.99 – 1.04 mmol/L |
3 tablets |
2 g over 30 – 60 minutes |
Within 4 – 6 hours of completing dose |
|
0.93 – 0.98 mmol/L |
Not recommended |
3 g over 60 minutes |
Within 4 – 6 hours of completing dose |
|
<0.93 mmol/L |
Not recommended |
4 g over 60 minutes and notify MD |
Within 4 – 6 hours of completing dose |
1 g calcium citrate = 10.5 mEq calcium.
Each tablet of calcium citrate + vitamin D contains 315 mg of calcium citrate (66 mg elemental calcium, 3.3 mEq calcium) and 250 units of vitamin D (cholecalciferol).
1 g calcium gluconate = 4.56 mEq calcium
Maximum rate of intravenous infusion = 1.5 mEq calcium/minute
Corrected serum [Ca++] (mg/dL) = measured serum [Ca++] (mg/dL) + [0.8 x (4 – serum albumin (g/dL))]
MAGNESIUM
Goal serum magnesium concentration 2.0 – 2.4 mg/dL
Intravenous Treatment of Hypomagnesemia
|
Serum magnesium concentration |
Intravenous magnesium sulfate dose† |
Oral magnesium oxide dose |
Recheck serum magnesium concentration |
|
|
1.6 – 1.9 mg/dL |
2 g |
800 mg |
4 to 6 hours after dose if symptomatic otherwise with next AM lab draw |
|
|
1.0 – 1.5 mg/dL |
4 g |
Not recommended |
4 to 6 hours after dose if symptomatic otherwise with next AM lab draw |
|
|
< 1.0 mg/dL |
6 g and notify MD |
Not recommended |
4 to 6 hours after dose if symptomatic otherwise with next AM lab draw |
|
|
Rate of intravenous infusion of magnesium |
Recommend infusing 1 g magnesium sulfate/hour (~8 mEq magnesium/hour), up to maximum of 2 g magnesium sulfate/hour (doses of up to 32 mEq magnesium can be given over 4 – 5 minutes in severe symptomatic hypomagnesemia (urgent or emergent situation)) |
|||
† 1 g magnesium sulfate = 8.1 mEq magnesium
**Consider adding scheduled oral magnesium oxide as indicated**
PHOSPHORUS / PHOSPHATE
Goal serum phosphorus concentration 2.7 – 4.6 mg/dL
Intravenous Treatment of Hypophosphatemia
|
Serum phosphorus concentration |
Intravenous phosphate dose*† |
Oral phosphate dose |
Recheck serum phosphorus concentration |
|
2.0 – 2.6 mg/dL |
15 mmol over 2 hours |
500 mg (16 mmol, 2 packets) |
With next AM lab draw |
|
1.5 – 2.0 mg/dL |
30 mmol over 4 hours |
1000 mg (32 mmol, 4 packets) |
Within 4 – 6 hours of completing dose |
|
< 1.5 mg/dL |
45 mmol over 6 hours |
Not recommended |
Within 4 – 6 hours of completing dose |
*Maximum infusion rate = 7 mmol phosphate/hour.
Per protocol all intravenous doses will be replaced as sodium phosphate. If patient is hypernatremic or
hypokalemic, contact physician regarding possibly replacing as potassium phosphate instead. A separate order will be needed for potassium phosphate.
1 mMol sodium phosphate = 1.33 mEq sodium
1 mMol potassium phosphate = 1.47 mEq potassium
Each packet of oral phosphate replacement contains 8 mmol phos, 7 mEq potassium, 7 mEq sodium