Electrolyte Replacement Guidelines

Replacement orders should only be used in patients with a serum creatinine less than 2
mg/dL, BUN less than 30 mg/dL, and urinary output greater than 30 mL/hr
Only the selected electrolytes will be replaced

ORAL POTASSIUM REPLACEMENT: asymptomatic patients able to take ORAL supplementation

Serum Potassium Level Replace with:
3.6 3.9 mMol/L
20 mEq oral x 1 dose
(aggressive treatment option only)
3.1 3.5 mMol/L 20 mEq oral every 2 hours x 2 doses
less than 3.1 mMol/L Contact provider for replacement orders
(notify provider) as IV replacement may be necessary
Repeat serum potassium level in AM
Check magnesium levels if potassium does not respond after two total replacement attempts
Potassium levels of 3.6 3.9 mMol/L will only be replaced if provider selects aggressive treatment option

IV POTASSIUM REPLACEMENT:
Serum Potassium Level Replace with:
3.6 3.9 mMol/L
20 mEq potassium chloride IVPB
(aggressive treatment option )
3.1 3.5 mMol/L 40 mEq potassium chloride IVPB
Less than 3.1 mMol/L 60 mEq potassium chloride IVPB
(notify provider) contact provider for further orders
Repeat serum potassium level 2 hours after the total replacement is completed
Notify provider and check magnesium level if potassium deficiency does not correct after two replacement
attempts.
Potassium levels of 3.6 3.9 mMol/L will only be replaced if provider selects aggressive treatment option

IV POTASSIUM PHOSPHATES REPLACEMENT: Use when phosphorus AND potassium need

replacement

Serum Phosphorus Level Serum Potassium Level Replace with:

15 mMol potassium phosphate IVPB
2 2.5 mg/dL 3.6 3.9 mMol/L
(equivalent to 22 mEq potassium)
30 mMol potassium phosphate IVPB
1 1.9 mg/dL 3.1 3.5 mMol/L
(equivalent to 44 mEq potassium)
less than 3.1 mMol/L
less than 1 mg/dL 45 mMol potassium phosphate IVPB
(notify provider for
(notify provider) (equivalent to 66 mEq potassium)
level less than 3.1 mMol/L)
Repeat serum potassium and phosphorus levels 6 hours after infusion is completed

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 IV SODIUM PHOSPHATES REPLACEMENT: Use when only phosphorus needs replacement
Serum Phosphorus Level Serum Sodium Level Replace with:
2 2.5 mg/dL less than 140 mMol/L 15 mMol sodium phosphate IVPB
1 1.9 mg/dL less than 140 mMol/L 30 mMol sodium phosphate IVPB
less than 1 mg/dL (notify provider) less than 140 mMol/L 45 mMol sodium phosphate IVPB
Repeat serum phosphorus level 6 hours after infusion is completed

IV MAGNESIUM REPLACEMENT:
Serum Magnesium Level Replace with:
less than 1.6 mg/dL
2 g magnesium sulfate IVPB
(notify provider if less than 1 mg/dL)
Repeat serum magnesium level 2 hours after the infusion is completed

Source: UMC Pharmacy Department Version: 2 Reviewed: 08/01/2016

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