Electrolyte Replacement - Critical Care ICU/PCU [ ] Protocol DATE/TIME PROVIDER INITIALS PHYSICIAN ORDERS. Height Weight Allergies

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Malcolm Blankenship
7 years ago
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1 Electrolyte Replacement - Critical Care Height Weight Allergies If serum creatinine greater than 2mg/dL and/or documentation of renal failure or dialysis, RN will contact physician for specific replacement orders. Consult pharmacist at Highline hospital. Protocol Electrolyte Protocol [X] Electrolyte Protocol [X] Electrolyte Replacement Protocol: Critical Care (ICU/PCU) [X] Potassium [X] Calcium, ionized [X] Magnesium [X] Phosphorus RN to order specific medication needed based on lab result. If creatinine greater than 2 mg/dl and/or documentation of Renal Failure or Dialysis, contact physician for specific replacement orders. Use ORAL when able. If multiple electrolytes to be replaced, please consult pharmacist. PRN. Check level 1 hour post infusion or 4 hours after oral dose(s) and replace per order. PRN. Check level 2 hour post infusion or 4 hours after oral dose(s) and replace per order. PRN. Check level 2 hour post infusion or 4 hours after oral dose(s) and replace per order. PRN. Check level 2 hour post 50 meq IV infusion and replace per order. Check level in AM after ORAL or 20 meq or 30 meq IV infusion and replace per orders. Highline Only Pharmacy Consult for patients with SCr >=2, renal failure, or receiving dialysis. [ ] Highline Only Pharmacy Consult for Electrolyte Replacement, Once, Starting today Page 1 of 7

2 Potassium Replacement If serum creatinine over 2 mg /dl and/or Documentation of Renal failure or Dialysis, contact MD for specific orders. POTASSIUM LEVEL (Single Response) ( ) potassium ORAL tablet 40 meq, Oral, Once, For 1 Doses For Potassium level mmol/l ( ) potassium ORAL liquid 40 meq, Oral, Once, For 1 Doses For Potassium level mmol/l ( ) potassium CENTRAL IV 40 meq, IntraVENous, for 2 Hours, Once, Starting today, For 1 Doses For Potassium level mmol/l ( ) potassium PERIPHERAL IV 40 meq, IntraVENous, for 4 Hours, Once, For 1 Doses 40 meq for Potassium level mmol/l POTASSIUM LEVEL (Single Response) ( ) potassium ORAL tablet 40 meq, Oral, Every 2 hours, For 2 Doses For Potassium level mmol/l ( ) potassium ORAL liquid 40 meq, Oral, Every 2 hours, For 2 Doses For Potassium level mmol/l ( ) potassium CENTRAL IV 40 meq, IntraVENous, for 2 Hours, Every 2 hours, Starting today, For 2 Doses For Potassium level mmol/l ( ) potassium PERIPHERAL IV 40 meq, IntraVENous, for 4 Hours, Every 4 hours interval, For 2 Doses 40 meq for Potassium level mmol/l Page 2 of 7

3 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. ( ) potassium PERIPHERAL IV 40 meq, IntraVENous, for 4 Hours, Every 2 hours, For 2 Doses 40 meq for Potassium level less than 2.2 mmol/l and notify MD if symptomatic. Page 3 of 7

4 Magnesium Replacement If serum creatinine over 2 mg /dl and/or Documentation of Renal failure or Dialysis, contact MD for specific orders. MAGNESIUM LEVEL (Single Response) ( ) magnesium ORAL liquid 30 ml, Oral, Daily as needed, other, give MOM or Magnesium oxide tablets once for Magnesium level mg/dl For Magnesium level mg/dl Recheck level 4 hours after oral dose and replace per order. ( ) magnesium ORAL tablet 800 mg, Oral, Once, For 1 Doses For Magnesium level mg/dl Recheck level 4 hours after oral dose and replace per order. ( ) magnesium IV 2 g, IntraVENous, for 0.5 Hours, Once, For 1 Doses For Magnesium level mg/dl Recheck level 2 hours post infusion and replace per orders. MAGNESIUM LEVEL LESS THAN 1.4 (Single Response) ( ) magnesium IV 4 g, IntraVENous, for 1 Hours, Once, For 1 Doses For Magnesium level less than 1.4 mg/dl Recheck level 2 hours post infusion and replace per orders. Page 4 of 7

5 Calcium Replacement If serum creatinine over 2 mg/dl and/or Documentation of Renal failure or Dialysis, contact MD for specific orders. Ionized CALCIUM LEVEL (Single Response) ( ) calcium ORAL 1,250 mg, Oral, Every 4 hours interval, First Dose Today, For 2 Doses For ionized Calcium level mmol/l 1250 mg calcium carbonate (equivalent to 500mg elemental calcium). ( ) calcium CENTRAL IV 1 g, IntraVENous, for 10 Minutes, Once, For 1 Doses For ionized Calcium level mmol/l If calcium chloride not available, pharmacist will change order to calcium gluconate 3 g over 1 hour once. Do NOT infuse in HAND or Small Veins. Do NOT infuse in same line WITH potassium or sodium PHOSPHATE, Max 200 mg (1mEq)/min ( ) calcium PERIPHERAL IV 3 g, IntraVENous, for 1 Hours, Once, For 1 Doses For ionized Calcium level mmol/l If calcium gluconate not available, pharmacist will change order to calcium chloride 1 g/50 ml over 1 hour once. Ionized CALCIUM LEVEL LESS THAN 1 (Single Response) ( ) calcium CENTRAL IV 2 g, IntraVENous, for 30 Minutes, Once, For 1 Doses For ionized Calcium level less than 1 mmol/l If calcium chloride not available, pharmacist will change order to calcium gluconate 3 g every 1 hour for 2 doses. Do NOT infuse in HAND or Small Veins. Do NOT infuse in same line WITH potassium or sodium PHOSPHATE, Max 200 mg (1mEq)/min ( ) calcium PERIPHERAL IV 3 g, IntraVENous, for 1 Hours, Every 1 hour, For 2 Doses For ionized Calcium level less than 1 mmol/l If calcium gluconate not available, pharmacist will change order to calcium chloride 2 g/50 ml over 1 hour once. Page 5 of 7

6 Phosphate Replacement If serum creatinine over 2 mg /dl and/or Documentation of Renal failure or Dialysis, contact MD for specific orders. PHOSPHORUS LEVEL (Single Response) ( ) Phosphate ORAL 2 packet, Oral, Every 2 hours, For 2 Doses For Phosphorus level mg/dl ( ) Phosphate CENTRAL IV 20 meq, IntraVENous, for 4 Hours, Once, For 1 Doses For Phosphorus level mg/dl ( ) Phosphate PERIPHERAL IV 20 meq, IntraVENous, for 4 Hours, Once, For 1 Doses For Phosphorus level mg/dl PHOSPHORUS LEVEL (Single Response) ( ) Phosphate IV 35 meq, IntraVENous, for 4 Hours, Once, For 1 Doses For Phosphorus level mg/dl PHOSPHORUS LEVEL LESS THAN 1 (Single Response) ( ) Phosphate IV 50 meq, IntraVENous, for 6 Hours, Once, For 1 Doses For Phosphorus level less than 1 mg/dl Date / Time Print Provider Name Provider Signature Date/Time RN Signature Acknowledgement Page 6 of 7

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Potassium Replacement

Potassium Replacement ** Always look at phosphorus level to determine appropriate potassium product ** K < 4.0 Phos > 2.5 Phos 2.5 Give KCl Give K Phos See Phos Protocol (additional KCl may be warranted)