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.

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

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

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