ICU Electrolyte Replacement Protocol

This protocol is for protocol electrolyte replacement in the ICU.
This protocol must be initiated by an order.
r/> Patients with the following items cannot be managed by this protocol:
1. Renal impairment (SCr >250 umol/L or urine output < 30 mL/hr).
2. Renal replacement therapy (intermittent hemodialysis, continuous renal replacement therapy, or peritoneal dialysis).
3. Diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS).
4. Rhabdomyolysis.
5. Parenteral nutrition.
6. Weight < 40 kg.
Click here to view the ICU Electrolyte Replacement Protocol.

Potassium Replacement

Mode Potassium level Repletion Recheck
Central line 3.6–3.9 mmol/L 20 mmol Potassium Chloride in 100 mL NS, over 1 hour 1 hr after infusion
Central line 3.2–3.5 mmol/L 40 mmol Potassium Chloride in 100 mL NS, over 2 hours 1 hr after infusion
Central line 2.9–3.1 mmol/L 40 mmol Potassium Chloride in 100 mL NS, over 2 hours, followed by 20 mmol Potassium Chloride in 100 mL NS over 1 hour 1 hr after infusion
Central line <2.9 mmol/L 40 mmol Potassium Chloride in 100 mL NS infused over 2 hours for 2 doses, and notify physician 1 hr after infusion
Peripheral IV 3.6–3.9 mmol/L 20 mmol Potassium Chloride in 250 mL NS, over 2 hours 1 hr after infusion
Peripheral IV 3.2–3.5 mmol/L 20 mmol Potassium Chloride in 250 mL NS, over 2 hours, times two doses 1 hr after infusions
Peripheral IV 2.9–3.1 mmol/L 20 mmol Potassium Chloride in 250 mL NS, over 2 hours, times three doses 1 hr after infusions
Peripheral IV <2.9 mmol/L 20 mmol Potassium Chloride in 250 mL NS, over 2 hours, times four doses, and notify physician 1 hr after infusions
Enteral or oral 3.6–3.9 mmol/L 20 mmol Potassium Chloride in 250 mL NS, over 2 hours 1 hr after infusion
Enteral or oral 3.2–3.5 mmol/L 20 mmol Potassium Chloride in 250 mL NS, over 2 hours, times two doses 1 hr after infusions
Enteral or oral 2.9–3.1 mmol/L 20 mmol Potassium Chloride in 250 mL NS, over 2 hours, times three doses 1 hr after infusions
Enteral or oral <2.9 mmol/L 40 mmol Potassium Chloride in 100 mL NS, over 2 hours for 2 doses, and notify physician 1 hr after infusion

Magnesium Replacement

Mode Magnesium level Repletion Recheck
Any IV access 0.66–0.8 mmol/L 8 mmol Magnesium Sulfate in 100 mL NS, over 1 hour Next morning
Any IV access 0.5–0.65 mmol/L 16 mmol Magnesium Sulfate in 250 mL NS, over 2 hours 4 hrs after infusion
Central line <0.5 mmol/L 16 mmol Magnesium Sulfate in 250 mL NS, over 2 hours, and notify physician 4 hrs after infusion
Enteral or oral 0.66–0.8 mmol/L 400mg Magnesium Oxide tablet enteral or oral twice daily Next morning

Phosphorous Replacement

Mode Phosphorous level Repletion Recheck
Any IV access 0.65–0.8 mmol/L 15 mmol Sodium Phosphate in 100 mL D5W over 2 hours Next morning
Central line <0.65 mmol/L 30 mmol Sodium Phosphate in 250 mL D5W over 4 hours, and notify physician 2 hrs after infusion
Enteral or oral 0.65–0.8 mmol/L 500mg Phosphorous tablet enteral or oral twice daily Next morning