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Guidelines for Electrolyte Replacement. EXCLUSIONS: Patients with the following: hemodialysis/peritoneal dialysis, acute kidney injury (AKI), creatinine clearance <30mL/min, chronic adrenal insufficiency, electrical burns, rhabdomyolysis, DKA, crush injury, hypothermia, or have active transfer orders out of the ICU/Step Down Unit.
Potassium replacement is primarily indicated when hypokalemia is due to potassium loss, and there is a significant deficit in body potassium.
Always look at potassium level to determine appropriate IV phosphorus product: use K Phos if K < 4.0 mEq/L and Na Phos if K 4.0 mEq/L. For IV replacement: Pharmacy will dilute in 250mL NS or D5W.
Potassium replacement should be routinely considered in patients with CHF, even if the initial potassium determination appears to be normal (eg, 4.0 mmol/L). The majority of patients with CHF are at increased risk for hypokalemia.
Potassium acetate may be useful for patients with metabolic acidosis. Typical rates: Rate of 10 mEq/hr for routine repletion. Rate of 20 mEq/hr for severe hypokalemia or DKA (either via a central line, or split into two simultaneous infusions of 10 mEq/hr in two peripheral lines).
POTASSIUM REPLACEMENT PROTOCOL – INTRAVENOUS. Recommended rate of infusion is 10 mEq/h. Maximum rate of intravenous replacement is 20 mEq/h with continuous ECG monitoring (the maximum rate may be increased to 40 mEq/h in emergency situations – see Policy #5080)
Potassium is available in multiple salt formulations, some administered orally (chloride, acetate, bicarbonate, gluconate, and citrate) and some intravenously (chloride and acetate). Certain potassium-containing compounds (eg, potassium chloride) can be injected subcutaneously (hypodermoclysis).
Hyperkalemia is a common clinical problem that is most often a result of impaired urinary potassium excretion due to acute or chronic kidney disease (CKD) and/or disorders or drugs that inhibit the renin-angiotensin-aldosterone system (RAAS). Therapy for hyperkalemia due to potassium retention is ultimately aimed at inducing potassium loss [1-3].
To prevent potassium loss or replace potassium lost by the body: Adults and teenagers—20 mEq mixed in 2 tablespoonfuls or more of cold water or juice taken two to four times a day. Your doctor may change the dose if needed.
Hypokalemia Overview. Hypokalemia is one of the most common electrolyte disturbances seen in clinical practice. The condition is more prevalent than hyperkalemia, though most hypokalemia cases are mild. Although variation exists, an acceptable lower limit for normal serum potassium is 3.5 mmol/L. [1] Hypokalemia is classified according to severity.